Provider Demographics
NPI:1053023416
Name:JENNINGS, BREANNA MICHELLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MICHELLE
Last Name:JENNINGS
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 1:498 PUETT COVE RD
Mailing Address - Street 2:
Mailing Address - City:MARBLE
Mailing Address - State:NC
Mailing Address - Zip Code:28905-9214
Mailing Address - Country:US
Mailing Address - Phone:828-361-6987
Mailing Address - Fax:
Practice Address - Street 1:498 PUETT COVE RD
Practice Address - Street 2:
Practice Address - City:MARBLE
Practice Address - State:NC
Practice Address - Zip Code:28905-9214
Practice Address - Country:US
Practice Address - Phone:828-361-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30000431235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist