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General NPI Number Information
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NPI Number | 1568238483
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Entity Type | Individual
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Provider Name | JALEN LEE FOUNTAIN
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Gender | Male
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 159 EXECUTIVE DR STE DANVILLE
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City | DANVILLE
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State | VA
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Zip | 24541-4160
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Country | US
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Telephone | 434-799-7732
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Fax |
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Provider Business Mailing Address
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Address Line | 2776 CHERRY GROVE RD
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City | YANCEYVILLE
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State | NC
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Zip | 27379-9194
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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