Provider Demographics
NPI:1992792725
Name:ESSE, JENNIFER JOY (AUD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOY
Last Name:ESSE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 ISLAND PARK DR # 200A
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7991
Mailing Address - Country:US
Mailing Address - Phone:843-971-4199
Mailing Address - Fax:843-971-4292
Practice Address - Street 1:895 ISLAND PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7991
Practice Address - Country:US
Practice Address - Phone:843-971-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3069231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3069OtherSTATE AUDIOLOGY LICENSE
SCSA0690Medicaid
SC3069OtherSTATE AUDIOLOGY LICENSE