Provider Demographics
NPI:1316195118
Name:PATE, JENNIFER PARKS (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PARKS
Last Name:PATE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 BURNT MILL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2654
Mailing Address - Country:US
Mailing Address - Phone:910-945-6072
Mailing Address - Fax:910-945-6169
Practice Address - Street 1:3311 BURNT MILL DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2654
Practice Address - Country:US
Practice Address - Phone:910-945-6072
Practice Address - Fax:910-945-6169
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist