Provider Demographics
NPI:1386901676
Name:ZEIEN, JENNIFER A (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:ZEIEN
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:RUNKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCCSLP
Mailing Address - Street 1:407 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-3309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 ALPINE DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-3309
Practice Address - Country:US
Practice Address - Phone:309-846-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009562235Z00000X
WI3469154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist