Provider Demographics
NPI:1124302112
Name:NEWELL, JANNICE VANESSA (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANNICE
Middle Name:VANESSA
Last Name:NEWELL
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 AUMAN DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-2754
Mailing Address - Country:US
Mailing Address - Phone:205-213-9314
Mailing Address - Fax:205-520-2090
Practice Address - Street 1:1513 AUMAN DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-2754
Practice Address - Country:US
Practice Address - Phone:205-213-9314
Practice Address - Fax:205-520-2090
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist