Provider Demographics
NPI:1457785420
Name:SHIELDS, JENA R (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENA
Middle Name:R
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:R
Other - Last Name:DRAGONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 FORSYTHE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5454
Mailing Address - Country:US
Mailing Address - Phone:910-829-0100
Mailing Address - Fax:
Practice Address - Street 1:400 FORSYTHE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5454
Practice Address - Country:US
Practice Address - Phone:910-829-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist