Provider Demographics
NPI:1447500483
Name:PERROTTA, JENNA S (MA SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:S
Last Name:PERROTTA
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 BONNIEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3808
Mailing Address - Country:US
Mailing Address - Phone:248-730-0570
Mailing Address - Fax:
Practice Address - Street 1:1734 BONNIEVIEW DR
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3808
Practice Address - Country:US
Practice Address - Phone:248-730-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MI7101004255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist