Healthcare Provider Details

I. General information

NPI: 1497065064
Provider Name (Legal Business Name): DIANNA L JENNINGS SPEECH AND LANGUAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E ADRIATIC ST # 7
KINGSVILLE MO
64061-9202
US

IV. Provider business mailing address

101 E ADRIATIC ST # 7
KINGSVILLE MO
64061-9202
US

V. Phone/Fax

Practice location:
  • Phone: 816-597-3422
  • Fax: 816-597-3702
Mailing address:
  • Phone: 816-597-3422
  • Fax: 816-597-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: