Provider Demographics
NPI:1831307982
Name:LAFFERTY, JEANNINE MARIE (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:MARIE
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1845
Mailing Address - Country:US
Mailing Address - Phone:304-933-3073
Mailing Address - Fax:304-933-3187
Practice Address - Street 1:351 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1845
Practice Address - Country:US
Practice Address - Phone:304-933-3073
Practice Address - Fax:304-933-3187
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002019Medicaid