Provider Demographics
NPI:1023761848
Name:CHILDRESS, JENNIFER GILMORE (DBH, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GILMORE
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:DBH, LAT, ATC
Other - Prefix:DR
Other - First Name:GINGER
Other - Middle Name:GILMORE
Other - Last Name:CHILDRESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DBH, LAT, ATC
Mailing Address - Street 1:323 PAUL BRYANT DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35487-0323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:323 PAUL BRYANT DRIVE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35487-0323
Practice Address - Country:US
Practice Address - Phone:205-310-9553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer