Provider Demographics
NPI:1063596369
Name:ASHWELL, JENNIFER ELLEN NEAL (MSP CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELLEN NEAL
Last Name:ASHWELL
Suffix:
Gender:F
Credentials:MSP CCC-SLP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ELLEN
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:564 SEVEN LAKES NORTH
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:NC
Mailing Address - Zip Code:27376
Mailing Address - Country:US
Mailing Address - Phone:336-972-3657
Mailing Address - Fax:
Practice Address - Street 1:564 SEVEN LAKES NORTH
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376
Practice Address - Country:US
Practice Address - Phone:336-972-3657
Practice Address - Fax:336-972-3657
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist