Provider Demographics
NPI:1316284227
Name:MURPH, JENNIFER TALLULAH (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:TALLULAH
Last Name:MURPH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 BELLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-3809
Mailing Address - Country:US
Mailing Address - Phone:803-682-5157
Mailing Address - Fax:
Practice Address - Street 1:1728 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-3809
Practice Address - Country:US
Practice Address - Phone:803-682-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist