Provider Demographics
NPI:1518590876
Name:MERCER, JENNA DANIELLE (CF-SLP, MED)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:DANIELLE
Last Name:MERCER
Suffix:
Gender:F
Credentials:CF-SLP, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 GLENWOOD AVE SE APT 528
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2096
Mailing Address - Country:US
Mailing Address - Phone:404-889-3031
Mailing Address - Fax:
Practice Address - Street 1:4798 HAIRSTON CROSSING RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3464
Practice Address - Country:US
Practice Address - Phone:404-889-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty