Provider Demographics
NPI:1467102756
Name:KLINGEMAN, TESSA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:KLINGEMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:O'LOUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:590 MISSOURI AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3084
Mailing Address - Country:US
Mailing Address - Phone:812-288-4688
Mailing Address - Fax:812-610-8333
Practice Address - Street 1:590 MISSOURI AVE STE 204
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3084
Practice Address - Country:US
Practice Address - Phone:812-288-4688
Practice Address - Fax:812-610-8333
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46003895A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist