Provider Demographics
NPI:1114567823
Name:DEHART, JESSICA DAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:DAWN
Last Name:DEHART
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1632
Mailing Address - Country:US
Mailing Address - Phone:862-485-6357
Mailing Address - Fax:
Practice Address - Street 1:176 GROVE ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1632
Practice Address - Country:US
Practice Address - Phone:862-485-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00487800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist