Provider Demographics
NPI:1043508880
Name:ELLER, JENNIFER HIGGINS (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HIGGINS
Last Name:ELLER
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 1:675 ROM ELLER RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:NC
Mailing Address - Zip Code:28624-9053
Mailing Address - Country:US
Mailing Address - Phone:336-973-4357
Mailing Address - Fax:
Practice Address - Street 1:4665 BLOWING ROCK BLVD.
Practice Address - Street 2:
Practice Address - City:BLOWING ROCK
Practice Address - State:NC
Practice Address - Zip Code:28605
Practice Address - Country:US
Practice Address - Phone:828-898-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist