Provider Demographics
NPI:1679293674
Name:MESSICK, JENNA ANDREAS RASHELL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ANDREAS RASHELL
Last Name:MESSICK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4660
Mailing Address - Country:US
Mailing Address - Phone:208-305-7076
Mailing Address - Fax:
Practice Address - Street 1:247 THAIN RD STE 104
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4800
Practice Address - Country:US
Practice Address - Phone:208-305-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-5416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist