Provider Demographics
NPI:1083113989
Name:PARTRIDGE, JAKE RYAN (MS SLP-CCC)
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:RYAN
Last Name:PARTRIDGE
Suffix:
Gender:M
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21257 HWY 177
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-7811
Mailing Address - Country:US
Mailing Address - Phone:618-599-8558
Mailing Address - Fax:
Practice Address - Street 1:21257 HWY 177
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-7811
Practice Address - Country:US
Practice Address - Phone:618-599-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015009734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist