Healthcare Provider Details

I. General information

NPI: 1871928085
Provider Name (Legal Business Name): JOCELYN SMALL SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WHITNEY RD
CONCORD NH
03301-1844
US

IV. Provider business mailing address

2 WHITNEY RD
CONCORD NH
03301-1844
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-4153
  • Fax: 603-565-1092
Mailing address:
  • Phone: 603-225-4153
  • Fax: 603-565-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1497
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: