Provider Demographics
NPI:1316684251
Name:GROGAN, JENNA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GROGAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:UTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:401 CORMORANT PL
Mailing Address - Street 2:3207
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:443-605-7246
Mailing Address - Fax:
Practice Address - Street 1:6901 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3780
Practice Address - Country:US
Practice Address - Phone:410-887-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02362L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist