Provider Demographics
NPI:1972943330
Name:SWARTZBERG, JENNA LEIGH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
Last Name:SWARTZBERG
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 1:838 PEACHTREE HILLS CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-4249
Mailing Address - Country:US
Mailing Address - Phone:770-265-2165
Mailing Address - Fax:
Practice Address - Street 1:3756 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5614
Practice Address - Country:US
Practice Address - Phone:404-477-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14037689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist