Provider Demographics
NPI:1114570181
Name:KAZBOUR, JESSICA SAWICKI (AUD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SAWICKI
Last Name:KAZBOUR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SAWICKI
Other - Last Name:KAZBOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:342A BUNA RD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1360
Mailing Address - Country:US
Mailing Address - Phone:813-310-9997
Mailing Address - Fax:
Practice Address - Street 1:4801 RADFORD AVE STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3541
Practice Address - Country:US
Practice Address - Phone:804-215-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2272231H00000X
VA2201001732231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist