Provider Demographics
NPI:1013584838
Name:SPONSEL, JESSICA ANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:SPONSEL
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 1:1401 S REECE RD
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-9485
Mailing Address - Country:US
Mailing Address - Phone:316-558-2193
Mailing Address - Fax:
Practice Address - Street 1:6731 W 121ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2003
Practice Address - Country:US
Practice Address - Phone:913-239-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist