Provider Demographics
NPI:1417344946
Name:MAY, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MAY
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 1:5700 TAPADERA TRACE LN
Mailing Address - Street 2:#325
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6301
Mailing Address - Country:US
Mailing Address - Phone:319-431-7764
Mailing Address - Fax:
Practice Address - Street 1:5700 TAPADERA TRACE LN
Practice Address - Street 2:#325
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-6301
Practice Address - Country:US
Practice Address - Phone:319-431-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist