Debra Funderburk Jolly, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3935 Issued in NC

Practice address

14408 Planters Knob LN
Charlotte, NC 28273-7847

Phone

(704) 807-0760

NPI assigned

Jul 23, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mrs. Debra Funderburk Pelhan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343001600000",
    "number": "1902151210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14408 PLANTERS KNOB LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282737847",
            "telephone_number": "704-807-0760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14408 PLANTERS KNOB LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282737847",
            "telephone_number": "704-807-0760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLY",
        "first_name": "DEBRA",
        "middle_name": "FUNDERBURK",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-23",
        "last_updated": "2012-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "3935",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "786",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "2002 MEDICAID PROVIDER (OUTDATED)",
            "identifier": "7411800",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "PELHAN",
            "middle_name": "FUNDERBURK",
            "prefix": "MRS.",
            "credential": "CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Josef Edmund Jolissaint, MD
• Michele L. Jolley, LPN
• Robert Jolley, MD
• Tracy Jolley, RPH
• Cumi Talitha Jolly, LCSW
• Jonathan Feather, PSYD, PLLC
• Jones Pharmacy Enterprises Inc (Gieant Genie Closed Pharmacy)
• Jones Pharmacy Enterprises Inc (Giant Genie Pharmacy)
• Jones Pharmacy Enterprises, Inc. (Giant Genie Pharmacy)
• Ashley M Jones-Lowery

• Speech-Language Pathologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.