Provider Demographics
NPI:1639501984
Name:ZIELINSKI, JESSICA NICOLE (SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:ZIELINSKI
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 1:110 VIRGIL ST
Mailing Address - Street 2:SPECIAL SERVICES
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2637
Mailing Address - Country:US
Mailing Address - Phone:636-240-2072
Mailing Address - Fax:636-240-2072
Practice Address - Street 1:110 VIRGIL ST
Practice Address - Street 2:SPECIAL SERVICES
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2637
Practice Address - Country:US
Practice Address - Phone:636-240-2072
Practice Address - Fax:636-240-2072
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013027484235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist