Provider Demographics
NPI:1043659089
Name:JARRETT, JEAN MARIE (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:JARRETT
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 1:405 EVERETT PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1210
Mailing Address - Country:US
Mailing Address - Phone:919-525-5119
Mailing Address - Fax:919-336-7522
Practice Address - Street 1:405 EVERETT PL
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1210
Practice Address - Country:US
Practice Address - Phone:919-525-5119
Practice Address - Fax:919-336-7522
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-21-54209103K00000X
NC10515235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst