Provider Demographics
NPI:1699152926
Name:ISENHOUR, JO REVELLE MURRAY (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:REVELLE MURRAY
Last Name:ISENHOUR
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 1:4330 SOUTHPORT SUPPLY RD SE STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-9273
Mailing Address - Country:US
Mailing Address - Phone:910-612-1002
Mailing Address - Fax:910-755-5865
Practice Address - Street 1:4979 SOUTHPORT SUPPLY RD SE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8742
Practice Address - Country:US
Practice Address - Phone:910-612-1002
Practice Address - Fax:910-755-5865
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist