Provider Demographics
NPI:1316725450
Name:DIETRICH, JENNA (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:ZANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3011 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-8614
Mailing Address - Country:US
Mailing Address - Phone:217-440-0898
Mailing Address - Fax:
Practice Address - Street 1:804 STATE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4968
Practice Address - Country:US
Practice Address - Phone:217-430-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist