Provider Demographics
NPI:1639321151
Name:REDDAWAY, JENNIFER JOYCE (AUD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOYCE
Last Name:REDDAWAY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 WINDY HILL RD SE STE 307
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8655
Mailing Address - Country:US
Mailing Address - Phone:678-486-1051
Mailing Address - Fax:770-953-9474
Practice Address - Street 1:2550 WINDY HILL RD SE STE 307
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8655
Practice Address - Country:US
Practice Address - Phone:678-486-1051
Practice Address - Fax:770-953-9474
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3529231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA264610031AOtherMEDICAID O & P NUMBER