Provider Demographics
NPI:1235279266
Name:LATHROP, JENNIFER FARGO (MA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:FARGO
Last Name:LATHROP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:JEAN
Other - Last Name:FARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:496 1ST ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-3676
Mailing Address - Country:US
Mailing Address - Phone:650-941-0664
Mailing Address - Fax:650-941-2892
Practice Address - Street 1:496 1ST ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-3676
Practice Address - Country:US
Practice Address - Phone:650-941-0664
Practice Address - Fax:650-941-2892
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268231H00000X
CA1068237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80567ZMedicare ID - Type Unspecified