Provider Demographics
NPI:1003220179
Name:TONNESSEN, JESSICA M (MS, SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:TONNESSEN
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:MULSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:PO BOX 5020
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5020
Mailing Address - Country:US
Mailing Address - Phone:701-857-5105
Mailing Address - Fax:701-857-5646
Practice Address - Street 1:407 3RD ST SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4470
Practice Address - Country:US
Practice Address - Phone:701-857-5514
Practice Address - Fax:701-857-2604
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist