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General NPI Number Information
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NPI Number | 1730384066
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Entity Type | Individual
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Provider Name | JESSICA RENAE DENNIS SLP
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13731 HICKMAN RD
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City | URBANDALE
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State | IA
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Zip | 50323-2193
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Country | US
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Telephone | 515-331-6907
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Fax | 515-331-6952
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Provider Business Mailing Address
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Address Line | 305 NE GRANT ST
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City | ANKENY
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State | IA
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Zip | 50021-1809
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Country | US
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Telephone | 515-963-8071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 01515
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License Number State | IA
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