Provider Demographics
NPI:1407085723
Name:TELCHIN, JESSICA ADRIENNE (MS CCC-SLP)
Entity Type:Individual
Prefix:PROF
First Name:JESSICA
Middle Name:ADRIENNE
Last Name:TELCHIN
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 1:19808 DINNER KEY DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4504
Mailing Address - Country:US
Mailing Address - Phone:561-251-0103
Mailing Address - Fax:
Practice Address - Street 1:19808 DINNER KEY DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4504
Practice Address - Country:US
Practice Address - Phone:561-251-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL09144922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885215400Medicaid