Provider Demographics
NPI:1700289923
Name:SELLARS, JENNIFER JILL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JILL
Last Name:SELLARS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 STARDUST TRL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7390 MCGINNIS FERRY RD
Practice Address - Street 2:#100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1291
Practice Address - Country:US
Practice Address - Phone:678-473-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist