Provider Demographics
NPI:1972278380
Name:MEINBRESSE, JESSICA AMANDA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:AMANDA
Last Name:MEINBRESSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 SPOTTED EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1255
Mailing Address - Country:US
Mailing Address - Phone:732-865-5435
Mailing Address - Fax:
Practice Address - Street 1:8677 ADDISON PLACE CIR UNIT 302
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-7868
Practice Address - Country:US
Practice Address - Phone:336-692-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist