Provider Demographics
NPI:1871333096
Name:JENNINGS, BROOKE E (AUD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:E
Last Name:JENNINGS
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 1:25 WOODS LAKE RD STE 401
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2763
Mailing Address - Country:US
Mailing Address - Phone:864-770-8822
Mailing Address - Fax:864-770-8882
Practice Address - Street 1:25 WOODS LAKE RD STE 401
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2763
Practice Address - Country:US
Practice Address - Phone:864-770-8822
Practice Address - Fax:864-770-8882
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7969231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist