Provider Demographics
NPI:1396036927
Name:FENWICK, JANELLE ELISE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:ELISE
Last Name:FENWICK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:JANELLE
Other - Middle Name:ELISE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:10 HENRYS HILL LANE
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312
Mailing Address - Country:US
Mailing Address - Phone:919-336-9521
Mailing Address - Fax:919-336-4515
Practice Address - Street 1:10 HENRYS HILL LANE
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312
Practice Address - Country:US
Practice Address - Phone:919-336-9521
Practice Address - Fax:919-336-4515
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-01
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist