Provider Demographics
NPI:1376570044
Name:MONROE, JAN P (MSED CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:P
Last Name:MONROE
Suffix:
Gender:F
Credentials:MSED CCC SLP
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:PARKER
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED CCC SLP
Mailing Address - Street 1:229 SCALYBARK RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485
Mailing Address - Country:US
Mailing Address - Phone:843-832-0879
Mailing Address - Fax:
Practice Address - Street 1:301 OAKBROOK LANE
Practice Address - Street 2:SUITE 335
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485
Practice Address - Country:US
Practice Address - Phone:843-832-1795
Practice Address - Fax:843-832-9499
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3738235Z00000X
HISP403235Z00000X
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA01096055OtherASHA