Individual
MRS. JENNY LYLE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
121B LEE ST, CARROLLTON, GA 30117-3314
(770) 830-8622
(770) 832-9031
Mailing address
2548 OLD NEWNAN RD, CARROLLTON, GA 30116-9020
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006776
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126664544A
—
GA
Enumeration date
12/20/2007
Last updated
05/15/2008
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