Healthcare Provider Details

I. General information

NPI: 1417867607
Provider Name (Legal Business Name): JENNIFER CLOOS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER DELAGE

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5514 LORI LN W
WEST FARGO ND
58078-8557
US

IV. Provider business mailing address

5514 LORI LN W
WEST FARGO ND
58078-8557
US

V. Phone/Fax

Practice location:
  • Phone: 218-252-2628
  • Fax:
Mailing address:
  • Phone: 218-252-2628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2626
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: