Provider Demographics
NPI:1689975831
Name:HORGAN, JENNIFER W (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:W
Last Name:HORGAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:108 BELFAIR RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8040
Mailing Address - Country:US
Mailing Address - Phone:803-738-6144
Mailing Address - Fax:803-825-4830
Practice Address - Street 1:108 BELFAIR RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8040
Practice Address - Country:US
Practice Address - Phone:803-738-6144
Practice Address - Fax:803-825-4830
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist