Provider Demographics
NPI:1447697370
Name:HOLBROOK, JENNIFER D (MCD, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:D
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:2675 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1478
Mailing Address - Country:US
Mailing Address - Phone:704-824-7800
Mailing Address - Fax:704-824-2822
Practice Address - Street 1:197 PIEDMONT BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1846
Practice Address - Country:US
Practice Address - Phone:803-639-8066
Practice Address - Fax:803-366-7755
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235Z00000X
SC5352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist