Jessica Hendrickson
Individual provider Active NPI Speech-Language Pathologist · Victoria, MN
NPI 1790355758 · NPPES record last updated Jun 30, 2021
Key facts
- NPI
- 1790355758
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 10561 (MN)
- Practice address
- 1772 Stieger Lake LN
Victoria, MN 55386-7723 - Phone
- (952) 443-9888
- NPI assigned
- Jun 30, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211005003348 | MN | Practitioner - Qualified Speech Language Pathologist | 4587062583 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kid Talk Inc | Current |
Accepting new patients | |
| Kid Talk Inc | Speech-Language Pathologist | Current |
Accepting new patients |
Locations
8758 Egan Dr
Savage, MN 55378
Phone (952) 226-2999
1772 Stieger Lake Ln
Victoria, MN 55386
Phone (952) 443-9888
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 10561 | MN | Yes |
Addresses
Primary practice location
1772 Stieger Lake LN
Victoria, MN 55386-7723
Mailing address
1772 Stieger Lake LN
Victoria, MN 55386-7723
Phone (952) 443-9888
Other providers in Victoria, MN
- Abigail Gray
- Matthew Paul Green
- Erin Guyette
- Jeanna Hamlett
- Andrew Michael Hawkins
- Christine Herzog
- His House Foundation
- Cynthia Marie Huntimer
- Heather Marlene Hurley Vangerud
- Inner Compass LLC
All providers in Victoria, MN · Speech-Language Pathologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.