Provider Demographics
NPI:1508517616
Name:JENNINGS, ESSIE J (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ESSIE
Middle Name:J
Last Name:JENNINGS
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:HONOMU
Mailing Address - State:HI
Mailing Address - Zip Code:96728-0068
Mailing Address - Country:US
Mailing Address - Phone:808-209-7165
Mailing Address - Fax:
Practice Address - Street 1:2148 AWAPUHI STREET
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5290
Practice Address - Country:US
Practice Address - Phone:808-365-8128
Practice Address - Fax:808-961-6383
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR235Z00000X
HIST-1692235Z00000X
HISP1692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist