Provider Demographics
NPI:1033474416
Name:SPERSTAD, JESSICA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SPERSTAD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:204 W WARREN ST
Mailing Address - Street 2:PO BOX 220
Mailing Address - City:ROBERTS
Mailing Address - State:WI
Mailing Address - Zip Code:54023-9617
Mailing Address - Country:US
Mailing Address - Phone:715-749-3890
Mailing Address - Fax:715-749-4081
Practice Address - Street 1:204 W WARREN ST
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:WI
Practice Address - Zip Code:54023-9617
Practice Address - Country:US
Practice Address - Phone:715-749-3890
Practice Address - Fax:715-749-4081
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3577-154235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist