Healthcare Provider Details

I. General information

NPI: 1497665897
Provider Name (Legal Business Name): CAMERON HENNESSY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMERON LENHART

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1973 FAISON AVE
FORT MILL SC
29708-8433
US

IV. Provider business mailing address

1973 FAISON AVE
FORT MILL SC
29708-8433
US

V. Phone/Fax

Practice location:
  • Phone: 704-285-8207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30005676
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9871
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: