Provider Demographics
NPI:1174273536
Name:KERN, JESSIE LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:LEE
Last Name:KERN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:LEE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 SIMMS AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0578
Mailing Address - Country:US
Mailing Address - Phone:712-310-5971
Mailing Address - Fax:
Practice Address - Street 1:1000 SIMMS AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0578
Practice Address - Country:US
Practice Address - Phone:712-310-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist