Provider Demographics
NPI:1649923020
Name:SENSIBAUGH, JACQUELYN MARIE
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:MARIE
Last Name:SENSIBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 CLARENDON WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7002
Mailing Address - Country:US
Mailing Address - Phone:209-373-0597
Mailing Address - Fax:
Practice Address - Street 1:1458 CLARENDON WAY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7002
Practice Address - Country:US
Practice Address - Phone:209-373-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist