Individual
MARY GRACE JAQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., CCC-SLP
Contact information
Practice address
40 PROFESSIONAL DR, JEFFERSON, GA 30549-6333
(114) 170-6367
Mailing address
475 BALDWIN ST APT 14, ATHENS, GA 30605-5152
(706) 399-1865
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP010476
—
Other
Enumeration date
05/22/2019
Last updated
05/22/2019
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