Provider Demographics
NPI:1194467845
Name:DORTCH, JESSICA READLING (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:READLING
Last Name:DORTCH
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 DRAWBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8096
Mailing Address - Country:US
Mailing Address - Phone:704-450-9699
Mailing Address - Fax:
Practice Address - Street 1:111 KILSON DR STE 104
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8218
Practice Address - Country:US
Practice Address - Phone:980-317-0985
Practice Address - Fax:704-360-4467
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist