Provider Demographics
NPI:1174909170
Name:KREIDER, JANINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:KREIDER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BRIDGEWATER LANE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305-4700
Mailing Address - Country:US
Mailing Address - Phone:912-248-2734
Mailing Address - Fax:
Practice Address - Street 1:300 BRIDGEWATER LANE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305-3130
Practice Address - Country:US
Practice Address - Phone:912-248-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist