Healthcare Provider Details

I. General information

NPI: 1811406705
Provider Name (Legal Business Name): JONELLDA EDUCATIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2017
Last Update Date: 09/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S LIBERTY ST
BENNETTSVILLE SC
29512-4076
US

IV. Provider business mailing address

3079 ADAMSVILLE RD N
BENNETTSVILLE SC
29512-5905
US

V. Phone/Fax

Practice location:
  • Phone: 843-544-7179
  • Fax:
Mailing address:
  • Phone: 843-544-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: AMANDA KELLY
Title or Position: OWNER
Credential:
Phone: 843-544-7179