Provider Demographics
NPI:1669531729
Name:VARNADO, JENNIFER MICHELE (SLP006625)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELE
Last Name:VARNADO
Suffix:
Gender:F
Credentials:SLP006625
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:GOSCICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SA7372
Mailing Address - Street 1:7170 DEVONHALL WAY
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1898
Mailing Address - Country:US
Mailing Address - Phone:407-970-4583
Mailing Address - Fax:
Practice Address - Street 1:7170 DEVONHALL WAY
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1898
Practice Address - Country:US
Practice Address - Phone:407-970-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7372235Z00000X
GASLP006625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888295900Medicaid