Provider Demographics
NPI:1235388067
Name:DESY, JENNIE REBECCA (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:REBECCA
Last Name:DESY
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 KEMPSVILLE RD STE 221
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-623-0526
Mailing Address - Fax:757-623-0609
Practice Address - Street 1:885 KEMPSVILLE RD STE 221
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-623-0526
Practice Address - Fax:757-627-6471
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001443231H00000X
DE02-0000145231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist