Provider Demographics
NPI:1043680259
Name:CREED, JENNIFER LYN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:CREED
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:DERUSHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:615 E HOBCAW DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2549
Mailing Address - Country:US
Mailing Address - Phone:724-396-4901
Mailing Address - Fax:
Practice Address - Street 1:615 E HOBCAW DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2549
Practice Address - Country:US
Practice Address - Phone:724-396-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4912235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist