Provider Demographics
NPI:1629223722
Name:BORMANN, JENNIFER JEAN (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JEAN
Last Name:BORMANN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:JEAN
Other - Last Name:BLOMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:8714 LYNDALE AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55420
Mailing Address - Country:US
Mailing Address - Phone:952-948-9695
Mailing Address - Fax:952-948-9086
Practice Address - Street 1:8714 LYNDALE AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55420
Practice Address - Country:US
Practice Address - Phone:952-948-9695
Practice Address - Fax:952-948-9086
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6369231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist