Provider Demographics
NPI:1679807788
Name:BUFORD, JENNIFER (CCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BUFORD
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 CEDAR POINT CIR
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-6412
Mailing Address - Country:US
Mailing Address - Phone:229-273-3217
Mailing Address - Fax:229-273-3217
Practice Address - Street 1:196 CEDAR POINT CIR
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-6412
Practice Address - Country:US
Practice Address - Phone:229-273-3217
Practice Address - Fax:229-273-3217
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist