Provider Demographics
NPI:1932263209
Name:HIGGINS, JENNIFER (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HIGGINS
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 1:9876 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3970
Mailing Address - Country:US
Mailing Address - Phone:678-494-6906
Mailing Address - Fax:678-494-6908
Practice Address - Street 1:9876 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3970
Practice Address - Country:US
Practice Address - Phone:678-494-6906
Practice Address - Fax:678-494-6908
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10034966OtherAMERIGROUP PROVIDER NUMBE
GA338822OtherWELLCARE PROVIDER NUMBER