Provider Demographics
NPI:1457169674
Name:PARKER, JEANNIE RAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:RAE
Last Name:PARKER
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 1:3200 HIGHWAY 100 S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2175
Mailing Address - Country:US
Mailing Address - Phone:651-380-9959
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHWAY 100 S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2175
Practice Address - Country:US
Practice Address - Phone:651-380-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14280836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist