Provider Demographics
NPI:1144415118
Name:PURDY, JENNIFER GIBSON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GIBSON
Last Name:PURDY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4808 LAFITE LN
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1247
Mailing Address - Country:US
Mailing Address - Phone:864-903-0807
Mailing Address - Fax:
Practice Address - Street 1:4808 LAFITE LN
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-1247
Practice Address - Country:US
Practice Address - Phone:864-903-0807
Practice Address - Fax:864-903-0807
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist