Provider Demographics
NPI:1326421652
Name:CRIDER, JESSIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:CRIDER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 WELLS PURDOM DR
Mailing Address - Street 2:
Mailing Address - City:ALMO
Mailing Address - State:KY
Mailing Address - Zip Code:42020-9240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:193 WELLS PURDOM DR
Practice Address - Street 2:
Practice Address - City:ALMO
Practice Address - State:KY
Practice Address - Zip Code:42020-9240
Practice Address - Country:US
Practice Address - Phone:270-293-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist