Provider Demographics
NPI:1700363769
Name:MANSUR, JESSICA LYNN (AUD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:MANSUR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:STRZEPEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:324 E SAINT JOHN ST STE B
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1505
Mailing Address - Country:US
Mailing Address - Phone:864-655-8300
Mailing Address - Fax:864-603-1555
Practice Address - Street 1:324 E SAINT JOHN ST STE B
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1505
Practice Address - Country:US
Practice Address - Phone:864-655-8300
Practice Address - Fax:864-603-1555
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4102231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist