Provider Demographics
NPI:1073035820
Name:STILES, JENESSA JOANA (AUD)
Entity Type:Individual
Prefix:DR
First Name:JENESSA
Middle Name:JOANA
Last Name:STILES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 BEAVER DRIVE, PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0308
Mailing Address - Country:US
Mailing Address - Phone:814-375-0455
Mailing Address - Fax:814-375-2721
Practice Address - Street 1:871 BEAVER DRIVE
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3767
Practice Address - Country:US
Practice Address - Phone:814-375-0455
Practice Address - Fax:814-375-2721
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006511231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist