Provider Demographics
NPI:1205902335
Name:PHILLIPS, JENNIFER BRAND (MED CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BRAND
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MED CCC SLP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:BRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED CFY SLP
Mailing Address - Street 1:4127 BETTY FORD ROAD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130
Mailing Address - Country:US
Mailing Address - Phone:615-848-1719
Mailing Address - Fax:
Practice Address - Street 1:420 N UNIVERSITY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:615-893-2602
Practice Address - Fax:615-890-1224
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist