Provider Demographics
NPI:1023203288
Name:RITTER, JESSIE (MA, CCC-SLP, LSLS)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:RITTER
Suffix:
Gender:F
Credentials:MA, CCC-SLP, LSLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E HILDEBRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2693
Mailing Address - Country:US
Mailing Address - Phone:210-824-0632
Mailing Address - Fax:210-824-8514
Practice Address - Street 1:603 E HILDEBRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2693
Practice Address - Country:US
Practice Address - Phone:210-824-0632
Practice Address - Fax:210-824-8514
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24860OtherSTATE BOARD OF EXAMINERS