Provider Demographics
NPI:1437327970
Name:ADAMS, JENNIFER WALL (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WALL
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 JONES CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-7612
Mailing Address - Country:US
Mailing Address - Phone:864-643-7732
Mailing Address - Fax:
Practice Address - Street 1:115 E LAKEMONT DR
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6713
Practice Address - Country:US
Practice Address - Phone:912-576-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24076235Z00000X
GA004335235Z00000X
SC5085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist