MEDICARE: JENESSA DAWN BRANCHER M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP-1619	NV

General Provider Information

NPI Number	:	1154754505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENESSA DAWN BRANCHER M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	3244 RIDGECLIFF ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8126
Country	:	US
Telephone Number	:	702-305-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	3244 RIDGECLIFF ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8126
Country	:	US
Telephone Number	:	702-305-1434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/17/2020

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