Provider Demographics
NPI:1306919154
Name:JENNINGS, JANNIE HOUSE (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANNIE
Middle Name:HOUSE
Last Name:JENNINGS
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:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-1109
Mailing Address - Country:US
Mailing Address - Phone:770-868-5810
Mailing Address - Fax:770-868-5810
Practice Address - Street 1:80 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1714
Practice Address - Country:US
Practice Address - Phone:770-868-5810
Practice Address - Fax:770-868-5810
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003468OtherSTATE LISENCE
GA00695857CMedicaid