Provider Demographics
NPI:1871788794
Name:ARQUETTE, JENNIFER (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ARQUETTE
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 1:296 APPLE BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6387
Mailing Address - Country:US
Mailing Address - Phone:828-264-3003
Mailing Address - Fax:
Practice Address - Street 1:4665 BLOWING ROCK BLVD LENOIR NC 28645
Practice Address - Street 2:146
Practice Address - City:BLOWING ROCK
Practice Address - State:NC
Practice Address - Zip Code:28605-0146
Practice Address - Country:US
Practice Address - Phone:828-898-7194
Practice Address - Fax:828-757-0002
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411364Medicaid
NC4660OtherNC LICENSE