Individual
JENNIFER ENNIS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
140 WOFFORD RD, CONWAY, SC 29526-8815
(843) 455-7505
(866) 668-9946
Mailing address
140 WOFFORD RD, CONWAY, SC 29526-8815
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3066
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0359
—
SC
Enumeration date
06/17/2006
Last updated
07/08/2007
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