Provider Demographics
NPI:1205224649
Name:PARKER, JESSICA RENEE (MS)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:RENEE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-0332
Mailing Address - Country:US
Mailing Address - Phone:601-319-7303
Mailing Address - Fax:
Practice Address - Street 1:668 OLD SALT RD
Practice Address - Street 2:
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482-4232
Practice Address - Country:US
Practice Address - Phone:601-758-0982
Practice Address - Fax:601-758-0982
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist