Provider Demographics
NPI:1205226131
Name:SCAGGS, JENNIFER (MA CCC- SLP, LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SCAGGS
Suffix:
Gender:F
Credentials:MA CCC- SLP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:OH
Mailing Address - Zip Code:43018-0291
Mailing Address - Country:US
Mailing Address - Phone:740-490-2414
Mailing Address - Fax:740-860-4686
Practice Address - Street 1:2700 E MAIN ST STE 109
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2581
Practice Address - Country:US
Practice Address - Phone:740-490-2414
Practice Address - Fax:740-860-4686
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026692225700000X
OHSP-10564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist