Provider Demographics
NPI:1194290122
Name:ROBERT, JEANNETTE A (MA)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:A
Last Name:ROBERT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 WINDERMERE DR
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6494
Mailing Address - Country:US
Mailing Address - Phone:954-461-8064
Mailing Address - Fax:
Practice Address - Street 1:845 CHURCH ST N STE 306
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4375
Practice Address - Country:US
Practice Address - Phone:046-734-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1562237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1562OtherNORTH CAROLINA STATE HEARING AID DEALERS AND FITTERS BOARD