Provider Demographics
NPI:1255595237
Name:DANNREUTHER, JACQUELINE M (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:M
Last Name:DANNREUTHER
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 E COTTONWOOD PKWY STE 660
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-0001
Mailing Address - Country:US
Mailing Address - Phone:850-473-0112
Mailing Address - Fax:850-473-0118
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:STE 315
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8771
Practice Address - Country:US
Practice Address - Phone:850-473-0112
Practice Address - Fax:850-473-0118
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 1493231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist