Nicklas, Jennifer

Nicklas, Jennifer is an individual health care provider with primary practice located at 1115 Fairgrounds Rd , Jefferson City MO 65109-5443. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Nicklas, Jennifer can be contacted via phone (573) 634-3070.

Contact Information

Primary practice address
1115 Fairgrounds Rd Jefferson City MO 65109-5443
Phone: (573) 634-3070
Fax: (573) 636-3247
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X 2009005833 Missouri

Profile Details

NPI number 1770706038
LBN Legal business name Nicklas, Jennifer
Credentials CCC-SLP
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 11th, 2007
Last updated Apr 7th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770706038 NPPES
Missouri MEDICAID 461466500

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