Provider Demographics
NPI:1487774493
Name:COGGIOLA, JENNIFER LORRAINE (SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:COGGIOLA
Suffix:
Gender:F
Credentials:SLP
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Other - First Name:
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Mailing Address - Street 1:3256 MCNUTT AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-1833
Mailing Address - Country:US
Mailing Address - Phone:925-323-0175
Mailing Address - Fax:925-935-6730
Practice Address - Street 1:3256 MCNUTT AVE
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-1833
Practice Address - Country:US
Practice Address - Phone:925-323-0175
Practice Address - Fax:925-935-6730
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist