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NPI Code Detail

MEDICARE: JENNIFER SUE DONOUGHE MS CCC SLP

MEDICARE: JENNIFER SUE DONOUGHE MS CCC SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist6643NC
2235Z00000XSpeech-Language Pathologist27268CA

General Provider Information

NPI Number : 1639364433
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER SUE DONOUGHE MS CCC SLP
Provider Business Mailing Address
First Line : 1601 PURDUE DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3674
Country : US
Telephone Number : 910-672-0061
Fax Number : 910-672-0061
Provider Business Practice Location Address
First Line : 1601 PURDUE DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3674
Country : US
Telephone Number : 910-672-0061
Fax Number : 910-672-0061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2007
Last Update Date : 06/20/2024

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