Provider Demographics
NPI:1104179464
Name:MOREHEAD, JESSICA PAULETTE (SLP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:PAULETTE
Last Name:MOREHEAD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BLUE SPRINGS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-7894
Mailing Address - Country:US
Mailing Address - Phone:304-663-8810
Mailing Address - Fax:
Practice Address - Street 1:55 BLUE SPRINGS BRANCH RD
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179-7894
Practice Address - Country:US
Practice Address - Phone:304-663-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist