| Doctor Name: | MRS. JESSICA T NIEDERKORN |
| NPI Number: | 1366444846 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., CCC-SLP |
| License Number: | SLP005748 |
| Business Practice Address: | 313 Briarmoor Dr Warner Robins, GA - 310887951 |
| Business Phone Number: | 4782182982 |
| Business Fax Number: | |
| Mailing Address: | 313 Briarmoor Dr, WARNER ROBINS |
| State: | GA |
| Postal Code: | 310887951 |
| Phone Number: | 4782182982 |
| Fax Number: | |
| NPI Enumeration Date: | 08/15/2005 |
| NPI Last Update Date: | 05/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/22/2006 |
| NPI Reactivation Date: | 04/12/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP005748 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |