Provider Demographics
NPI:1770909756
Name:ELROD, JENNIFER (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ELROD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:VACHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:5016 MAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4326
Mailing Address - Country:US
Mailing Address - Phone:419-989-5245
Mailing Address - Fax:
Practice Address - Street 1:4741 TROUSDALE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1332
Practice Address - Country:US
Practice Address - Phone:615-290-5397
Practice Address - Fax:615-823-2958
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist