Provider Demographics
NPI:1104045186
Name:ACKERMAN, JESSICA L (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:DEFALCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:2207 WASHINGTON ST
Mailing Address - Street 2:#2
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1155
Mailing Address - Country:US
Mailing Address - Phone:781-571-9417
Mailing Address - Fax:
Practice Address - Street 1:150 YORK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1829
Practice Address - Country:US
Practice Address - Phone:781-297-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist