Provider Demographics
NPI:1780464818
Name:JACOVETTI, BRENNA (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:JACOVETTI
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 1:737 PEACHTREE HILLS CIR NE UNIT 737
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-4246
Mailing Address - Country:US
Mailing Address - Phone:770-876-7634
Mailing Address - Fax:
Practice Address - Street 1:737 PEACHTREE HILLS CIR NE UNIT 737
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-4246
Practice Address - Country:US
Practice Address - Phone:770-876-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist