Provider Demographics
NPI:1942041959
Name:LOVAAS, JENA GAYL (CFY-SLP)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:GAYL
Last Name:LOVAAS
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 28TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3140
Mailing Address - Country:US
Mailing Address - Phone:701-318-0889
Mailing Address - Fax:
Practice Address - Street 1:4575 23RD AVE S STE 500
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8784
Practice Address - Country:US
Practice Address - Phone:701-347-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN528865235Z00000X
ND2662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist