Provider Demographics
NPI:1679216550
Name:DENNIS, JESSICA MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 ROUND LEAF RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-1098
Mailing Address - Country:US
Mailing Address - Phone:405-513-3620
Mailing Address - Fax:
Practice Address - Street 1:14715 BRISTOL PARK BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1894
Practice Address - Country:US
Practice Address - Phone:405-840-1686
Practice Address - Fax:405-840-1006
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist