Provider Demographics
NPI:1073274700
Name:IRVIN, JESSIE ANNE
Entity Type:Individual
Prefix:PROF
First Name:JESSIE
Middle Name:ANNE
Last Name:IRVIN
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 1:2329 ANGLER LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5335
Mailing Address - Country:US
Mailing Address - Phone:571-265-0379
Mailing Address - Fax:
Practice Address - Street 1:2329 ANGLER LN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-5335
Practice Address - Country:US
Practice Address - Phone:571-265-0379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist