MEDICARE: MRS. CAROL DEMONTMOLLIN JENNINGS MSP, 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
1	235Z00000X	Speech-Language Pathologist	428	SC

General Provider Information

NPI Number	:	1114196029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL DEMONTMOLLIN JENNINGS MSP, CCC-SLP

Provider Business Mailing Address
First Line	:	315 SPRINGCREEK CT
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-2473
Country	:	US
Telephone Number	:	803-356-0449
Fax Number	:	803-808-3873

Provider Business Practice Location Address
First Line	:	315 SPRINGCREEK CT
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-2473
Country	:	US
Telephone Number	:	803-356-0449
Fax Number	:	803-808-3873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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