Provider Demographics
NPI:1225589559
Name:BREWER, JESSICA WALKER (MS CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:WALKER
Last Name:BREWER
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:PAIGE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:9583 US HIGHWAY 221 N
Mailing Address - Street 2:
Mailing Address - City:CRUMPLER
Mailing Address - State:NC
Mailing Address - Zip Code:28617-9412
Mailing Address - Country:US
Mailing Address - Phone:336-977-8233
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-6507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1705227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist