Provider Demographics
NPI:1851165690
Name:MICHAELS, JENNIFER BOND
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BOND
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BOND
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:4377 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-1837
Mailing Address - Country:US
Mailing Address - Phone:319-252-7875
Mailing Address - Fax:
Practice Address - Street 1:12400 OLIVE BLVD STE 425
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5458
Practice Address - Country:US
Practice Address - Phone:314-275-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002429235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist