Basic Information
| Provider Information | |||||||||
| NPI: | 1780862490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEPHART | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2295 HENRY CLOWER BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300785707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709959600 | ||||||||
| FaxNumber: | 6783834556 | ||||||||
| Practice Location | |||||||||
| Address1: | 2295 HENRY CLOWER BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300785707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709959600 | ||||||||
| FaxNumber: | 6783834556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2008 | ||||||||
| LastUpdateDate: | 10/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP005990 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.