Provider Demographics
NPI:1497347082
Name:LEDGER-MOORE, JESSICA (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:LEDGER-MOORE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44038 45TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-9683
Mailing Address - Country:US
Mailing Address - Phone:405-886-7203
Mailing Address - Fax:
Practice Address - Street 1:44038 45TH ST STE A
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-9683
Practice Address - Country:US
Practice Address - Phone:405-821-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2262355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant