Provider Demographics
NPI:1124250071
Name:TEIPEN, JESSICA BETH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BETH
Last Name:TEIPEN
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 1:514 DORMAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3536
Mailing Address - Country:US
Mailing Address - Phone:317-502-5701
Mailing Address - Fax:
Practice Address - Street 1:7393 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 500
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9269
Practice Address - Country:US
Practice Address - Phone:317-272-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004849A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist