Provider Demographics
NPI:1669967394
Name:GARZAREK, JESSICA EMMONS (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EMMONS
Last Name:GARZAREK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LANE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MAYLENE
Mailing Address - State:AL
Mailing Address - Zip Code:35114-6085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 LANE PARK DR
Practice Address - Street 2:
Practice Address - City:MAYLENE
Practice Address - State:AL
Practice Address - Zip Code:35114-6085
Practice Address - Country:US
Practice Address - Phone:205-547-1652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist