Individual
MRS. JESSICA NIEDERKORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
4034 ROUNDTOP CIR, PERRY, GA 31069-7806
(478) 718-0573
Mailing address
4034 ROUNDTOP CIR, PERRY, GA 31069-7806
(478) 718-0573
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005748
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
639235193K
—
GA
Enumeration date
08/15/2005
Last updated
06/30/2022
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