Individual
MRS. JENNIFER CLARK BAUCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
6688 MAIN ST, GLOUCESTER, VA 23061-5194
(804) 210-1555
Mailing address
PO BOX 130, GLOUCESTER, VA 23061-0130
(804) 210-1555
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202003940
VA
Other
Enumeration date
05/23/2007
Last updated
07/27/2010
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