Provider Demographics
NPI:1366295768
Name:NEATHERY, JENNIFER ILICH (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ILICH
Last Name:NEATHERY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FLEMING FOREST DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-8727
Mailing Address - Country:US
Mailing Address - Phone:919-671-2623
Mailing Address - Fax:
Practice Address - Street 1:100 SUNSET DR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-9403
Practice Address - Country:US
Practice Address - Phone:919-562-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist