Provider Demographics
NPI:1225042187
Name:JEFFRIES, JACQUELINE DIANE (BSC SLP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:DIANE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:BSC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FORDHAM DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5368
Mailing Address - Country:US
Mailing Address - Phone:757-361-3954
Mailing Address - Fax:757-361-3951
Practice Address - Street 1:1400 FORDHAM DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5368
Practice Address - Country:US
Practice Address - Phone:757-361-3954
Practice Address - Fax:757-361-3951
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist