Provider Demographics
NPI:1760732325
Name:GUERIN, JENNIFER C (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:GUERIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 N GLOUCESTER PL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1212
Mailing Address - Country:US
Mailing Address - Phone:404-543-7296
Mailing Address - Fax:888-978-5662
Practice Address - Street 1:1816 BRIARWOOD INDUSTRIAL CT NE STE A
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1642
Practice Address - Country:US
Practice Address - Phone:404-543-7296
Practice Address - Fax:888-978-5662
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist