Basic Information
| Provider Information | |||||||||
| NPI: | 1396212817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARTON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | MSP, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1004 10TH ST | ||||||||
| Address2: | |||||||||
| City: | PORT ROYAL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299352310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433109690 | ||||||||
| FaxNumber: | 8003179690 | ||||||||
| Practice Location | |||||||||
| Address1: | 1004 10TH ST | ||||||||
| Address2: | |||||||||
| City: | PORT ROYAL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299352310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433109690 | ||||||||
| FaxNumber: | 8003179690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2018 | ||||||||
| LastUpdateDate: | 11/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 4365 | SC | N | Speech, Language and Hearing Service Providers | Audiologist | 235Z00000X | 4365 | SC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.