Provider Demographics
NPI:1013948546
Name:CLAY, JEANNE (MA, CC-SP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:MA, CC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-2823
Mailing Address - Country:US
Mailing Address - Phone:712-276-6599
Mailing Address - Fax:
Practice Address - Street 1:1140 LINCOLN ST NE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3318
Practice Address - Country:US
Practice Address - Phone:712-546-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist