Healthcare Provider Details

I. General information

NPI: 1972139996
Provider Name (Legal Business Name): JENNIFER KATE GEISMAR M.ED., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 03/21/2020
Certification Date: 03/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST
CHATTANOOGA TN
37403-2147
US

IV. Provider business mailing address

975 E 3RD ST
CHATTANOOGA TN
37403-2147
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-2059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4225
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: