Provider Demographics
NPI:1730412875
Name:MUCKALA, JENNIFER CIES (MA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CIES
Last Name:MUCKALA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 PRIEST PL
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2698
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:615-343-0872
Practice Address - Street 1:1215 21ST AVE S
Practice Address - Street 2:7302 MCE SOUTH TOWER
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0014
Practice Address - Country:US
Practice Address - Phone:615-343-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000002932235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist