Jessica B Reynolds, MS CCC SLP
Individual provider Active NPI Speech-Language Pathologist · Centralia, MO
NPI 1184759003 · NPPES record last updated Sep 19, 2012
Key facts
- NPI
- 1184759003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 2004020295 (MO)
- Practice address
- 750 E Highway 22
Centralia, MO 65240-1146 - Phone
- (573) 682-3015
- Fax
- (573) 682-3015
- NPI assigned
- Feb 22, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004020295 | MO | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2004020295 | MO | Yes |
Addresses
Primary practice location
750 E Highway 22
Centralia, MO 65240-1146
Mailing address
750 E Highway 22
Centralia, MO 65240-1146
Phone (573) 682-3015
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 469269310 | Medicaid | MO |
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- Jayden Marie Rawlings
- Trisa Rea Redington
- Rehab Care
- Deanna D Richman
- Emily M Riddle
- Anna Romine
- Tayler Scholes
- Smile Dental Centralia LLC
All providers in Centralia, MO · Speech-Language Pathologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.