Basic Information
| Provider Information | |||||||||
| NPI: | 1982983839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAUSCHECK | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11070 108TH AVE N | ||||||||
| Address2: | |||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553692612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122021524 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 LOVELL AVE W | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551134459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514843378 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2011 | ||||||||
| LastUpdateDate: | 08/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 8823 | MN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.