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General NPI Number Information
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NPI Number | 1558689562
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Entity Type | Individual
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Provider Name | JENNIFER KAY SELF MS CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 05/14/2010
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Last Update Date | 05/14/2010
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Provider Practice Location Address
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Address Line | 1260 HIGHTOWER TRL
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City | ATLANTA
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State | GA
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Zip | 30350-6248
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Country | US
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Telephone | 770-594-3434
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Fax | 770-594-3434
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Provider Business Mailing Address
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Address Line | 2222 SULLIVAN TRL
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City | EASTON
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State | PA
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Zip | 18040-7958
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Country | US
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Telephone | 800-944-9782
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Fax | 610-438-2024
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP005598
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License Number State | GA
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