Provider Demographics
NPI:1245849546
Name:DOMBEK, JENNIFER J (HIS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:J
Last Name:DOMBEK
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:668 BELLS HWY
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2706
Mailing Address - Country:US
Mailing Address - Phone:843-782-3866
Mailing Address - Fax:
Practice Address - Street 1:321 BELLS HWY
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2703
Practice Address - Country:US
Practice Address - Phone:843-782-3866
Practice Address - Fax:843-782-3866
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHT-1011247000000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information