Individual
JENNIFER A. BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
24 FALCON DR, AUBURN, ME 04210-4384
(207) 782-5437
(207) 753-0105
Mailing address
16 MADISON AVE, OXFORD, ME 04270-3579
(207) 743-7035
(207) 743-2970
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1713
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26179099
—
ME
Enumeration date
03/13/2007
Last updated
06/11/2009
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