Provider Demographics
NPI:1861527426
Name:SPOONSTER, JESSICA DAWN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:SPOONSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:138 TOMAHAWK
Mailing Address - City:ELSBERRY
Mailing Address - State:MO
Mailing Address - Zip Code:63343-0106
Mailing Address - Country:US
Mailing Address - Phone:573-898-5554
Mailing Address - Fax:573-898-3140
Practice Address - Street 1:138 TOMAHAWK
Practice Address - Street 2:ELSBERRY R-II
Practice Address - City:ELSBERRY
Practice Address - State:MO
Practice Address - Zip Code:63343-0106
Practice Address - Country:US
Practice Address - Phone:573-898-5554
Practice Address - Fax:573-898-3140
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005004544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist