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NPI Code Detail

MEDICARE: JENNIFER MCCORMICK M.S., CCC-SLP

MEDICARE: JENNIFER MCCORMICK M.S., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist16354FL
2235Z00000XSpeech-Language Pathologist4038TN

General Provider Information

NPI Number : 1790139582
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MCCORMICK M.S., CCC-SLP
Provider Business Mailing Address
First Line : 646 HILLTOP DR
Second Line :
City : JACKSBORO
State : TN
Zip : 37757-2033
Country : US
Telephone Number : 615-924-3077
Fax Number :
Provider Business Practice Location Address
First Line : 220 LONGMIRE RD
Second Line :
City : CLINTON
State : TN
Zip : 37716-7338
Country : US
Telephone Number : 865-457-6925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2016
Last Update Date : 01/02/2021

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Directions to “ JENNIFER MCCORMICK M.S., CCC-SLP” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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