Provider Demographics
NPI:1629038070
Name:BODENSTEINER, JENNIFER P (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:P
Last Name:BODENSTEINER
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:P
Other - Last Name:HAWK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4101 NW 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226
Mailing Address - Country:US
Mailing Address - Phone:515-963-9422
Mailing Address - Fax:
Practice Address - Street 1:301 N ANKENY BLVD SUITE 200
Practice Address - Street 2:ANKENY PHYSICAL SPORTS THERAPY
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021
Practice Address - Country:US
Practice Address - Phone:515-965-1422
Practice Address - Fax:515-965-1449
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0166547Medicaid
IA0166547Medicaid