Provider Demographics
NPI:1912205634
Name:WASHINGTON, JENNIFER (MS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 ORR DR
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-4055
Mailing Address - Country:US
Mailing Address - Phone:404-317-6025
Mailing Address - Fax:404-766-5692
Practice Address - Street 1:1294 HIGHWAY 54 W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4518
Practice Address - Country:US
Practice Address - Phone:770-755-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106514235Z00000X
GA007086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist