Provider Demographics
NPI:1215271580
Name:CRAIG, JENNIFER (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CRAIG
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 1:1706A ASHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5110
Mailing Address - Country:US
Mailing Address - Phone:239-898-0798
Mailing Address - Fax:
Practice Address - Street 1:1215 21ST AVE S
Practice Address - Street 2:7302 MEDICAL CENTER EAST, SOUTH TOWER
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0014
Practice Address - Country:US
Practice Address - Phone:615-936-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist