Provider Demographics
NPI:1285872044
Name:NORMAN, JENNIFER PARRIS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PARRIS
Last Name:NORMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 CHATEAU DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9008
Mailing Address - Country:US
Mailing Address - Phone:229-888-1413
Mailing Address - Fax:
Practice Address - Street 1:4522 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-9008
Practice Address - Country:US
Practice Address - Phone:229-888-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist