Provider Demographics
NPI:1295202695
Name:JELSING, JESSIE LEE
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:LEE
Last Name:JELSING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 WINSOME LN APT 131
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5508
Mailing Address - Country:US
Mailing Address - Phone:425-870-3658
Mailing Address - Fax:
Practice Address - Street 1:6041 WINSOME LN APT 131
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5508
Practice Address - Country:US
Practice Address - Phone:425-870-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist