Provider Demographics
NPI:1073996104
Name:XANDER, JESSICA GRACE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRACE
Last Name:XANDER
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-3107
Mailing Address - Country:US
Mailing Address - Phone:443-642-8971
Mailing Address - Fax:
Practice Address - Street 1:15005 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1017
Practice Address - Country:US
Practice Address - Phone:301-805-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program