Provider Demographics
NPI:1477315307
Name:MASSEY, JESSICA GRACE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRACE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38620-9455
Mailing Address - Country:US
Mailing Address - Phone:662-934-7973
Mailing Address - Fax:
Practice Address - Street 1:191 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2542
Practice Address - Country:US
Practice Address - Phone:662-292-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS-5115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist