Individual
MRS. JENNIFER MARIE WIDENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD, CCC-SLP
Contact information
Practice address
1720 KNOWLES RD, PHENIX CITY, AL 36869-7135
(334) 291-0485
Mailing address
6 STONERIDGE RD, CATAULA, GA 31804-2130
(229) 224-6826
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3296
AL
Other
Enumeration date
01/20/2016
Last updated
01/20/2016
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