Provider Demographics
NPI:1043525793
Name:BARTH, JEANNE MARIE (MA,CCC,SLP)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:BARTH
Suffix:
Gender:
Credentials:MA,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4022
Mailing Address - Country:US
Mailing Address - Phone:813-963-6923
Mailing Address - Fax:813-930-2426
Practice Address - Street 1:5708 SALT KETTLE CT
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4758
Practice Address - Country:US
Practice Address - Phone:813-389-2264
Practice Address - Fax:813-264-6923
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880866000Medicaid