Provider Demographics
NPI:1851512545
Name:PLANK, NIESJE A (CCC SLP MS)
Entity Type:Individual
Prefix:
First Name:NIESJE
Middle Name:A
Last Name:PLANK
Suffix:
Gender:F
Credentials:CCC SLP MS
Other - Prefix:
Other - First Name:NIESJE
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1610 EAST SUNSHINE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-767-2298
Mailing Address - Fax:417-767-4483
Practice Address - Street 1:1610 EAST SHUNSHINE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-523-7500
Practice Address - Fax:417-523-7595
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO467466306Medicaid