Provider Demographics
NPI:1346583366
Name:RAMBO, JESSIE (MS SLP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:RAMBO
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-1741
Mailing Address - Country:US
Mailing Address - Phone:417-235-4246
Mailing Address - Fax:417-235-5470
Practice Address - Street 1:800 E SCOTT ST
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1741
Practice Address - Country:US
Practice Address - Phone:417-235-4246
Practice Address - Fax:417-235-5470
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
MO2017043071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist