Provider Demographics
NPI:1548601628
Name:JESPERSEN, ANN MICHELLE (SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MICHELLE
Last Name:JESPERSEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3375
Mailing Address - Country:US
Mailing Address - Phone:540-446-2654
Mailing Address - Fax:540-656-2755
Practice Address - Street 1:2300 FALL HILL AVE
Practice Address - Street 2:SUITE 515
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3342
Practice Address - Country:US
Practice Address - Phone:540-741-0544
Practice Address - Fax:540-741-0546
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA22020070342355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant