Provider Demographics
NPI:1871597617
Name:LENTZ, JEANIE FRYE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JEANIE
Middle Name:FRYE
Last Name:LENTZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 LENTZ RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-1596
Mailing Address - Country:US
Mailing Address - Phone:704-682-4421
Mailing Address - Fax:
Practice Address - Street 1:463 LENTZ RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1596
Practice Address - Country:US
Practice Address - Phone:704-682-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136X5OtherBCBS NC
NC7412131Medicaid