Provider Demographics
NPI:1386847143
Name:NELSON, JENNIFER ELAINE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELAINE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-5107
Mailing Address - Country:US
Mailing Address - Phone:440-339-3685
Mailing Address - Fax:
Practice Address - Street 1:135 S EAGLE ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1513
Practice Address - Country:US
Practice Address - Phone:440-466-9831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP9075235Z00000X
OH09075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist