Individual
JO REVELLE MURRAY ISENHOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED CCC-SLP
Contact information
Practice address
4979 SOUTHPORT SUPPLY RD SE, SOUTHPORT, NC 28461-8742
(910) 612-1002
(910) 755-5865
Mailing address
4330 SOUTHPORT SUPPLY RD SE STE 201, SOUTHPORT, NC 28461-9273
(910) 612-1002
(910) 755-5865
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11157
NC
Other
Enumeration date
05/06/2015
Last updated
01/26/2021
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