Provider Demographics
NPI:1548739402
Name:WILLIAMS, JESSICA DEAN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38483 DESERT LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVLLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-4662
Mailing Address - Country:US
Mailing Address - Phone:301-643-4053
Mailing Address - Fax:
Practice Address - Street 1:26410 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-3862
Practice Address - Country:US
Practice Address - Phone:301-373-4365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09137186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist