Provider Demographics
NPI:1053077891
Name:BRENNER, JESSI DEE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:JESSI
Middle Name:DEE
Last Name:BRENNER
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 PROVIDENCE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6155
Mailing Address - Country:US
Mailing Address - Phone:310-903-2837
Mailing Address - Fax:
Practice Address - Street 1:220 VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4021
Practice Address - Country:US
Practice Address - Phone:405-762-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist