Provider Demographics
NPI:1750754487
Name:HERRING, JENNIFER A (MED, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:HERRING
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5359 REDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3723
Mailing Address - Country:US
Mailing Address - Phone:404-583-0380
Mailing Address - Fax:
Practice Address - Street 1:5359 REDFIELD RD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-3723
Practice Address - Country:US
Practice Address - Phone:404-583-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist