Provider Demographics
NPI:1720400435
Name:JESKE, AGNES NADINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:AGNES
Middle Name:NADINE
Last Name:JESKE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-8452
Mailing Address - Country:US
Mailing Address - Phone:509-901-7187
Mailing Address - Fax:
Practice Address - Street 1:621 S. 13TH AVE.
Practice Address - Street 2:MCKINLEY ELEMENTARY SCHOOL
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-573-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60420586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist