Provider Demographics
NPI:1114409240
Name:SLAGER, JENNA ANN-VIERK (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN-VIERK
Last Name:SLAGER
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 1:354 OTTER RUN RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1582
Mailing Address - Country:US
Mailing Address - Phone:810-834-2145
Mailing Address - Fax:
Practice Address - Street 1:354 OTTER RUN RD
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1582
Practice Address - Country:US
Practice Address - Phone:810-834-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005873235Z00000X
MI7101006537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7101006537Medicaid
MI7101005873Medicaid