Provider Demographics
NPI:1841528460
Name:DAVIS, JENNIFER JAN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JAN
Last Name:DAVIS
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 1:1350 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202-2916
Mailing Address - Country:US
Mailing Address - Phone:717-264-6650
Mailing Address - Fax:
Practice Address - Street 1:1070 STOUFFER AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2938
Practice Address - Country:US
Practice Address - Phone:717-263-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist