Healthcare Provider Details

I. General information

NPI: 1992633325
Provider Name (Legal Business Name): JENNIFER NAESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER HANSON

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PATTERSON RD
SANTA MARIA CA
93455-4806
US

IV. Provider business mailing address

3230 FLORA ST
SAN LUIS OBISPO CA
93401-6052
US

V. Phone/Fax

Practice location:
  • Phone: 805-938-8794
  • Fax:
Mailing address:
  • Phone: 805-440-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: