Provider Demographics
NPI:1497265128
Name:HARRINGTON, JESSIE CARSON (CF-SLP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:CARSON
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:CARSON
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2054 RIVERSIDE AVE APT 3306
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2054 RIVERSIDE AVE APT 3306
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4444
Practice Address - Country:US
Practice Address - Phone:321-223-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist