Provider Demographics
NPI:1588911531
Name:HAUTAMAKI, JENNA M (SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:HAUTAMAKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:PHILIPPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 9TH ST N
Mailing Address - Street 2:ESSENTIA HEALTH VIRGINIA CLINIC
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2329
Mailing Address - Country:US
Mailing Address - Phone:218-741-0150
Mailing Address - Fax:
Practice Address - Street 1:1101 9TH ST N
Practice Address - Street 2:ESSENTIA HEALTH VIRGINIA CLINIC
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2329
Practice Address - Country:US
Practice Address - Phone:218-741-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist