Provider Demographics
NPI:1043751993
Name:WINSTON, JEAN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:WINSTON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 WHITEGRASS CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4180
Mailing Address - Country:US
Mailing Address - Phone:386-871-4493
Mailing Address - Fax:
Practice Address - Street 1:2270 LOGANVILLE HWY
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1623
Practice Address - Country:US
Practice Address - Phone:678-389-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-12
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist