Provider Demographics
NPI:1427264035
Name:PONTON, ZANETA ROSEBORO (MED, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ZANETA
Middle Name:ROSEBORO
Last Name:PONTON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N INDIANCREEK PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-7160
Mailing Address - Country:US
Mailing Address - Phone:919-957-8189
Mailing Address - Fax:
Practice Address - Street 1:16 N INDIANCREEK PL
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-7160
Practice Address - Country:US
Practice Address - Phone:919-957-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01108663OtherASHA MEMBER
NC3306OtherNC BOARD OF EXAMINERS