Provider Demographics
NPI:1376500561
Name:NIEDRINGHAUS, JACQUELYN DAVIS (AUD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:DAVIS
Last Name:NIEDRINGHAUS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2337
Mailing Address - Country:US
Mailing Address - Phone:803-327-1900
Mailing Address - Fax:803-327-4146
Practice Address - Street 1:1169 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2364
Practice Address - Country:US
Practice Address - Phone:803-327-1900
Practice Address - Fax:803-327-4146
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC457231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0017Medicaid
SCGP1087Medicaid
SCQ271605100Medicare PIN
SCSA0017Medicaid