Provider Demographics
NPI:1508387531
Name:LOWERY, JEFFERY NONE (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:NONE
Last Name:LOWERY
Suffix:
Gender:M
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-0278
Mailing Address - Country:US
Mailing Address - Phone:910-372-9300
Mailing Address - Fax:910-372-9302
Practice Address - Street 1:VIDANT DUPLIN REHABILLITATION
Practice Address - Street 2:514 S. MAIN STREET
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349
Practice Address - Country:US
Practice Address - Phone:910-372-9300
Practice Address - Fax:910-372-9302
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist