Provider Demographics
NPI:1003225582
Name:LAMBERTH, JENNIFER CALLIS (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CALLIS
Last Name:LAMBERTH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 CASCO CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7776
Mailing Address - Country:US
Mailing Address - Phone:803-785-2380
Mailing Address - Fax:
Practice Address - Street 1:180 MIDWAY ROAD
Practice Address - Street 2:MIDWAY ELEMENTARY SCHOOL
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7489
Practice Address - Country:US
Practice Address - Phone:803-821-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist