Provider Demographics
NPI:1093248122
Name:ATTARD, JESSICA SIMOES
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SIMOES
Last Name:ATTARD
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 1:2157 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-5836
Mailing Address - Country:US
Mailing Address - Phone:786-246-9055
Mailing Address - Fax:
Practice Address - Street 1:990 PONCE DE LEON BLVD
Practice Address - Street 2:APT 526
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-1238
Practice Address - Country:US
Practice Address - Phone:786-246-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13619235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist