Provider Demographics
NPI:1881808699
Name:CLOSSEN, JESSICA A (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:A
Last Name:CLOSSEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CARDINAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5563
Mailing Address - Country:US
Mailing Address - Phone:785-393-2438
Mailing Address - Fax:785-749-3055
Practice Address - Street 1:1429 KASOLD DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3425
Practice Address - Country:US
Practice Address - Phone:785-841-4262
Practice Address - Fax:785-749-3055
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2366235Z00000X
SC4482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist