Provider Demographics
NPI:1629057740
Name:STALLWORTH, JENNIFER LEE (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:STALLWORTH
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ERIN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4265
Mailing Address - Country:US
Mailing Address - Phone:864-455-5938
Mailing Address - Fax:864-250-9582
Practice Address - Street 1:14 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4246
Practice Address - Country:US
Practice Address - Phone:864-250-7944
Practice Address - Fax:864-250-9582
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS