Provider Demographics
NPI:1396212817
Name:PARTON, JENNIFER RAE (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:PARTON
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2310
Mailing Address - Country:US
Mailing Address - Phone:843-310-9690
Mailing Address - Fax:800-317-9690
Practice Address - Street 1:1004 10TH ST
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2310
Practice Address - Country:US
Practice Address - Phone:843-310-9690
Practice Address - Fax:800-317-9690
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4365231H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist