Provider Demographics
NPI:1295107654
Name:WEGNER, JESSICA DEINES (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DEINES
Last Name:WEGNER
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 W DOLORES CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68523-7220
Mailing Address - Country:US
Mailing Address - Phone:402-239-8239
Mailing Address - Fax:
Practice Address - Street 1:1255 W DOLORES CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68523-7220
Practice Address - Country:US
Practice Address - Phone:402-239-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist