Provider Demographics
NPI:1336862697
Name:MACKRIDES, JENNA LEE GRIER (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA LEE
Middle Name:GRIER
Last Name:MACKRIDES
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 1:1060 BEVERLY LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2736
Mailing Address - Country:US
Mailing Address - Phone:610-220-8249
Mailing Address - Fax:
Practice Address - Street 1:1400 W GONZALES RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3362
Practice Address - Country:US
Practice Address - Phone:805-983-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist