Provider Demographics
NPI:1225189574
Name:MURRY, JACQUELINE DENISE (PHD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DENISE
Last Name:MURRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 EASTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4170
Mailing Address - Country:US
Mailing Address - Phone:770-500-5508
Mailing Address - Fax:
Practice Address - Street 1:1894 EASTFIELD ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4170
Practice Address - Country:US
Practice Address - Phone:770-500-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist