Provider Demographics
NPI:1982048799
Name:JOLLY, RENEE STEIN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:STEIN
Last Name:JOLLY
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 1:4820 STUDBURY HALL CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9800
Mailing Address - Country:US
Mailing Address - Phone:919-609-5643
Mailing Address - Fax:919-400-4334
Practice Address - Street 1:4820 STUDBURY HALL CT
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9800
Practice Address - Country:US
Practice Address - Phone:919-609-5643
Practice Address - Fax:919-400-4334
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist