Provider Demographics
NPI:1801417076
Name:PLUMMER, JENNIFER (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials: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 1:18047 W CATAWBA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5688
Mailing Address - Country:US
Mailing Address - Phone:704-896-8688
Mailing Address - Fax:704-896-7975
Practice Address - Street 1:18047 W CATAWBA AVE STE 203
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5688
Practice Address - Country:US
Practice Address - Phone:704-896-8688
Practice Address - Fax:704-896-7975
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4609OtherNC BOARD OF EXAMINERS/STATE LICENSE