Provider Demographics
NPI:1578194437
Name:MONROE, JENNIFER (LMBT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 LEBANON RD STE D
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9112
Mailing Address - Country:US
Mailing Address - Phone:704-763-2059
Mailing Address - Fax:
Practice Address - Street 1:4732 LEBANON RD STE D
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9112
Practice Address - Country:US
Practice Address - Phone:704-763-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6397225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist