Provider Demographics
NPI:1003338294
Name:VIOLE, JENINE ENTWISTLE (MSP CCC-SLP LSLS AVT)
Entity Type:Individual
Prefix:MRS
First Name:JENINE
Middle Name:ENTWISTLE
Last Name:VIOLE
Suffix:
Gender:F
Credentials:MSP CCC-SLP LSLS AVT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:33 TRUMAN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4948
Mailing Address - Country:US
Mailing Address - Phone:203-522-9943
Mailing Address - Fax:
Practice Address - Street 1:3201 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1455
Practice Address - Country:US
Practice Address - Phone:336-541-8167
Practice Address - Fax:336-663-0266
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12928235Z00000X
SC6114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist