Provider Demographics
NPI:1467829341
Name:KUNZE, JESSICA CHRISTINA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CHRISTINA
Last Name:KUNZE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY CEDARS
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-5925
Mailing Address - Country:US
Mailing Address - Phone:609-709-3932
Mailing Address - Fax:
Practice Address - Street 1:1461 N HIGHVIEW LN
Practice Address - Street 2:APT 111
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-2308
Practice Address - Country:US
Practice Address - Phone:609-709-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist