Healthcare Provider Details

I. General information

NPI: 1497764484
Provider Name (Legal Business Name): JENNFER A GODFREY M.A. CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5165 CANAL STREET
MILTON FL
32570
US

IV. Provider business mailing address

2678 HIDDEN ESTATES CIRCLE
NAVARRE FL
32566
US

V. Phone/Fax

Practice location:
  • Phone: 850-936-0571
  • Fax:
Mailing address:
  • Phone: 850-936-0571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA8362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: