Provider Demographics
NPI:1801223979
Name:WENKEL, JENNIFER D
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:WENKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 S HOUSTON LAKE RD STE G
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2745
Mailing Address - Country:US
Mailing Address - Phone:478-333-2999
Mailing Address - Fax:478-900-1100
Practice Address - Street 1:1291 S HOUSTON LAKE RD STE G
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2745
Practice Address - Country:US
Practice Address - Phone:478-900-1100
Practice Address - Fax:478-900-1100
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist