Provider Demographics
NPI:1356989834
Name:GOLDEN, JENNIFER L (MCD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:PELION
Mailing Address - State:SC
Mailing Address - Zip Code:29123-8996
Mailing Address - Country:US
Mailing Address - Phone:803-821-2500
Mailing Address - Fax:803-821-2503
Practice Address - Street 1:7350 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:PELION
Practice Address - State:SC
Practice Address - Zip Code:29123-8996
Practice Address - Country:US
Practice Address - Phone:803-821-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist