Individual
MRS. JENNIFER M.D. HETHCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1853 OLD DONATION PKWY, VIRGINIA BEACH, VA 23454-3004
(757) 421-1180
Mailing address
6352 DARTMOUTH WAY, VIRGINIA BEACH, VA 23464-4608
(757) 803-5327
(757) 803-5327
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202004790
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1231877
CAQH
—
Enumeration date
07/25/2006
Last updated
03/20/2024
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