Provider Demographics
NPI:1568147429
Name:DURHAM, JENNA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3389 DOVER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-9507
Mailing Address - Country:US
Mailing Address - Phone:336-970-1437
Mailing Address - Fax:
Practice Address - Street 1:2125 SOUTHEND DR APT 240
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5048
Practice Address - Country:US
Practice Address - Phone:336-970-1437
Practice Address - Fax:336-294-8091
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program