Provider Demographics
NPI:1518293562
Name:MORRIS, JESSIE L (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:L
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MISS
Other - First Name:JESSIE
Other - Middle Name:L
Other - Last Name:CURTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:PARKIN
Mailing Address - State:AR
Mailing Address - Zip Code:72373-0252
Mailing Address - Country:US
Mailing Address - Phone:870-755-2737
Mailing Address - Fax:870-755-2740
Practice Address - Street 1:206 LAKE STREET
Practice Address - Street 2:
Practice Address - City:PARKIN
Practice Address - State:AR
Practice Address - Zip Code:72373
Practice Address - Country:US
Practice Address - Phone:870-755-2737
Practice Address - Fax:870-755-2740
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR174574795Medicaid