Provider Demographics
NPI:1952187817
Name:MCDONOUGH, JENNIFER SMITH (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SMITH
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-3100
Mailing Address - Country:US
Mailing Address - Phone:804-986-9505
Mailing Address - Fax:
Practice Address - Street 1:2755 LIVE OAK LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-3100
Practice Address - Country:US
Practice Address - Phone:804-986-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist