Provider Demographics
NPI:1598255333
Name:HENTGES, JADEE
Entity Type:Individual
Prefix:
First Name:JADEE
Middle Name:
Last Name:HENTGES
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 1:2795 PILOT KNOB RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1930
Mailing Address - Country:US
Mailing Address - Phone:651-994-9644
Mailing Address - Fax:
Practice Address - Street 1:14635 PENNOCK AVE STE 300
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6588
Practice Address - Country:US
Practice Address - Phone:651-994-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9879OtherSPEECH AND LANGUAGE LICENSE