Provider Demographics
NPI:1033833512
Name:KRAMLICH, JENNIFER M (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:KRAMLICH
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KIRTON TURN
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2422
Mailing Address - Country:US
Mailing Address - Phone:770-880-4175
Mailing Address - Fax:
Practice Address - Street 1:100 KIRTON TURN
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-2422
Practice Address - Country:US
Practice Address - Phone:770-880-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty