Provider Demographics
NPI:1902130636
Name:NUSS JENNISON, SONYA MISHELLE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:MISHELLE
Last Name:NUSS JENNISON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E HELBERT ST
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1643
Mailing Address - Country:US
Mailing Address - Phone:785-445-2752
Mailing Address - Fax:
Practice Address - Street 1:412 E HELBERT ST
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1643
Practice Address - Country:US
Practice Address - Phone:785-445-2752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8127235Z00000X
KS3078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist