Provider Demographics
NPI:1558450171
Name:RENFROE, GINA JERNIGAN (SLP-MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:JERNIGAN
Last Name:RENFROE
Suffix:
Gender:F
Credentials:SLP-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 1:110 MOURNING DOVE LN
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9529
Mailing Address - Country:US
Mailing Address - Phone:919-344-4742
Mailing Address - Fax:919-778-5878
Practice Address - Street 1:110 MOURNING DOVE LN
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9529
Practice Address - Country:US
Practice Address - Phone:919-344-4742
Practice Address - Fax:919-778-5878
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7471267Medicaid