Provider Demographics
NPI:1205185865
Name:RAINWATER, JESSICA ANN (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:RAINWATER
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10414 ENCHANTED
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-4763
Mailing Address - Country:US
Mailing Address - Phone:832-922-9164
Mailing Address - Fax:
Practice Address - Street 1:704 LONGMIRE RD
Practice Address - Street 2:#101
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1850
Practice Address - Country:US
Practice Address - Phone:936-441-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist