Provider Demographics
NPI:1902090921
Name:EYSERMANS, JENNIFER RENEA (MSCCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENEA
Last Name:EYSERMANS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 SAILMAKER DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6123
Mailing Address - Country:US
Mailing Address - Phone:972-315-5979
Mailing Address - Fax:
Practice Address - Street 1:215 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-5151
Practice Address - Country:US
Practice Address - Phone:817-285-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist