Provider Demographics
NPI:1326446170
Name:POTTER, JESSICA TAYLOR (AUD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:TAYLOR
Last Name:POTTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 MAPLE AVE
Mailing Address - Street 2:STE. 800
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5550
Mailing Address - Country:US
Mailing Address - Phone:518-584-0578
Mailing Address - Fax:
Practice Address - Street 1:414 MAPLE AVE
Practice Address - Street 2:STE. 800
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5550
Practice Address - Country:US
Practice Address - Phone:518-584-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002524-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist