Provider Demographics
NPI:1679803621
Name:DROUILLARD, JENNIFER LYNN (SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DROUILLARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S Y ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-6563
Mailing Address - Country:US
Mailing Address - Phone:731-693-2143
Mailing Address - Fax:
Practice Address - Street 1:6601 PHOENIX AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5092
Practice Address - Country:US
Practice Address - Phone:479-785-9091
Practice Address - Fax:479-782-3415
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4170235Z00000X
AR3084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist