Provider Demographics
NPI:1942743653
Name:GREER, JALISA R (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JALISA
Middle Name:R
Last Name:GREER
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 1:1462 S COLORADO STREET
Mailing Address - Street 2:APT 2G
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703
Mailing Address - Country:US
Mailing Address - Phone:414-698-7319
Mailing Address - Fax:
Practice Address - Street 1:1462 S COLORADO STREET
Practice Address - Street 2:APT 2G
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703
Practice Address - Country:US
Practice Address - Phone:414-698-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#4116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist