Healthcare Provider Details

I. General information

NPI: 1629038070
Provider Name (Legal Business Name): JENNIFER P BODENSTEINER MS CCCSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER P HAWK

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 50TH ST
DES MOINES IA
50310-2647
US

IV. Provider business mailing address

5602 ROSE AVE
DES MOINES IA
50321-1802
US

V. Phone/Fax

Practice location:
  • Phone: 515-635-4050
  • Fax: 515-631-5210
Mailing address:
  • Phone: 515-321-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01277
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: