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General NPI Number Information
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NPI Number | 1972278380
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Entity Type | Individual
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Provider Name | JESSICA AMANDA MEINBRESSE
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Gender | Female
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 8677 ADDISON PLACE CIR UNIT 302
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City | NAPLES
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State | FL
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Zip | 34119-7868
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Country | US
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Telephone | 336-692-0923
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Fax |
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Provider Business Mailing Address
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Address Line | 4045 SPOTTED EAGLE WAY
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City | FORT MYERS
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State | FL
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Zip | 33966-1255
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Country | US
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Telephone | 732-865-5435
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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 | SA15709
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License Number State | FL
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