Provider Demographics
NPI:1477834414
Name:STAHLECKER, JENNIFER L (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:STAHLECKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:401 SOUTH MARX STREET
Mailing Address - City:SPENCER
Mailing Address - State:NE
Mailing Address - Zip Code:68777-0057
Mailing Address - Country:US
Mailing Address - Phone:402-589-1408
Mailing Address - Fax:
Practice Address - Street 1:401 S MARX ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NE
Practice Address - Zip Code:68777-3603
Practice Address - Country:US
Practice Address - Phone:402-589-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist