Provider Demographics
NPI:1164824413
Name:ETHINGTON, JENNY MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:ETHINGTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 CEDAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-8074
Mailing Address - Country:US
Mailing Address - Phone:704-692-6599
Mailing Address - Fax:
Practice Address - Street 1:734 CEDAR HILL DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-8074
Practice Address - Country:US
Practice Address - Phone:704-692-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11578235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist