Provider Demographics
NPI:1972896421
Name:HATCHER, JENNIFER EVERETT (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EVERETT
Last Name:HATCHER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 WINNSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5376
Mailing Address - Country:US
Mailing Address - Phone:229-881-4244
Mailing Address - Fax:
Practice Address - Street 1:2336 DAWSON RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2800
Practice Address - Country:US
Practice Address - Phone:229-881-4244
Practice Address - Fax:229-312-8715
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126707AMedicaid