Individual
DR. JESSICA LENA FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, CCC-SLP
Contact information
Practice address
2222 TODD ST, EUGENE, OR 97405-1338
(541) 337-7086
Mailing address
2222 TODD ST, EUGENE, OR 97405-1338
(541) 337-7086
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12325
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13686504
BCBS-OREGON
OR
Enumeration date
07/21/2016
Last updated
07/21/2016
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