Provider Demographics
NPI:1710044714
Name:EHRHARDT, JENNIFER ELLIOTT (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELLIOTT
Last Name:EHRHARDT
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:ELLIOTT
Other - Last Name:JANUZELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:5345 AMHURST DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1627
Mailing Address - Country:US
Mailing Address - Phone:678-261-8771
Mailing Address - Fax:
Practice Address - Street 1:5345 AMHURST DR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1627
Practice Address - Country:US
Practice Address - Phone:678-261-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000817253AMedicaid