Provider Demographics
NPI:1730384066
Name:DENNIS, JESSICA RENAE (SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RENAE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NE GRANT ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-1809
Mailing Address - Country:US
Mailing Address - Phone:515-963-8071
Mailing Address - Fax:
Practice Address - Street 1:13731 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323-2193
Practice Address - Country:US
Practice Address - Phone:515-331-6907
Practice Address - Fax:515-331-6952
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01515235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist