Provider Demographics
NPI:1609229434
Name:GOULD, JENNIFER SUZANNE (MCD, SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:GOULD
Suffix:
Gender:F
Credentials:MCD, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SPRING TYME PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7288
Mailing Address - Country:US
Mailing Address - Phone:803-569-8913
Mailing Address - Fax:803-753-9415
Practice Address - Street 1:320 SPRING TYME PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7288
Practice Address - Country:US
Practice Address - Phone:803-553-1235
Practice Address - Fax:803-753-9415
Is Sole Proprietor?:No
Enumeration Date:2016-07-17
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist