Provider Demographics
NPI:1437337680
Name:ANDERSON, JESSICA (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 4TH AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4426
Mailing Address - Country:US
Mailing Address - Phone:949-282-1212
Mailing Address - Fax:
Practice Address - Street 1:450 4TH AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4426
Practice Address - Country:US
Practice Address - Phone:949-282-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2336237600000X
CAHA6018237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter