Provider Demographics
NPI:1629264593
Name:SNOTHERLY, JENNIFER SHAW (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SHAW
Last Name:SNOTHERLY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:WRENN
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27248-0005
Mailing Address - Country:US
Mailing Address - Phone:336-460-2618
Mailing Address - Fax:
Practice Address - Street 1:3127 WOW RD
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-7962
Practice Address - Country:US
Practice Address - Phone:336-460-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7261235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist