Provider Demographics
NPI:1871928085
Name:SMALL, JOCELYN (SLP)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-1844
Mailing Address - Country:US
Mailing Address - Phone:603-225-4153
Mailing Address - Fax:603-565-1092
Practice Address - Street 1:2 WHITNEY RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-1844
Practice Address - Country:US
Practice Address - Phone:603-225-4153
Practice Address - Fax:603-565-1092
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist