Healthcare Provider Details

I. General information

NPI: 1538079157
Provider Name (Legal Business Name): JONCIA JEREE GREEN SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 OAKLAND AVE
ROCK HILL SC
29730-4064
US

IV. Provider business mailing address

225 BENT HOLLY DR
HOPKINS SC
29061-3400
US

V. Phone/Fax

Practice location:
  • Phone: 803-661-5033
  • Fax: 864-643-2327
Mailing address:
  • Phone: 864-706-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6007
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: