Provider Demographics
NPI:1144558461
Name:GOSHORN, JENNIFER DAVIS (MA CCC-A)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DAVIS
Last Name:GOSHORN
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:DAVIS
Other - Last Name:GOSHORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-A
Mailing Address - Street 1:UNIVERSITY OF SOUTHERN MISSISSIPPI SPEECH
Mailing Address - Street 2:118 COLLEGE DRIVE # 5092
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39406-0001
Mailing Address - Country:US
Mailing Address - Phone:601-266-4968
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF SOUTHERN MISSISSIPPI SPEECH
Practice Address - Street 2:118 COLLEGE DRIVE # 5092
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39406-0001
Practice Address - Country:US
Practice Address - Phone:601-266-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3282237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter