Provider Demographics
NPI:1235657230
Name:SIENA, JENESSA
Entity Type:Individual
Prefix:
First Name:JENESSA
Middle Name:
Last Name:SIENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 SANGAMON RD
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:61554-1255
Mailing Address - Country:US
Mailing Address - Phone:309-267-8838
Mailing Address - Fax:
Practice Address - Street 1:418 SANGAMON RD
Practice Address - Street 2:
Practice Address - City:MARQUETTE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61554-1255
Practice Address - Country:US
Practice Address - Phone:309-267-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist