Provider Demographics
NPI:1154754505
Name:BRANCHER, JENESSA DAWN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENESSA
Middle Name:DAWN
Last Name:BRANCHER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JENESSA
Other - Middle Name:DAWN
Other - Last Name:MCCALLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:3244 RIDGECLIFF ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8126
Mailing Address - Country:US
Mailing Address - Phone:702-305-1434
Mailing Address - Fax:
Practice Address - Street 1:3244 RIDGECLIFF ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8126
Practice Address - Country:US
Practice Address - Phone:702-305-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1619235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist