Provider Demographics
NPI:1548559917
Name:MERSFELDER, JENNA ELIZABETH (MCD CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ELIZABETH
Last Name:MERSFELDER
Suffix:
Gender:F
Credentials:MCD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CENTURY BLVD NE STE 20
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3300
Mailing Address - Country:US
Mailing Address - Phone:404-633-8911
Mailing Address - Fax:404-633-6403
Practice Address - Street 1:1901 CENTURY BLVD NE STE 20
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3300
Practice Address - Country:US
Practice Address - Phone:404-633-8911
Practice Address - Fax:404-633-6403
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist