Individual
JENNA BOSARGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
212 W 3RD ST SW, ROME, GA 30165-2802
(706) 295-4242
(706) 295-4260
Mailing address
1114 S WALL ST, CALHOUN, GA 30701-3062
(706) 624-3000
(706) 624-3001
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP012243
GA LICENSE
GA
Enumeration date
08/15/2022
Last updated
08/15/2022
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