Provider Demographics
NPI:1588819031
Name:DUFFETT, JESSICA (EDD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:DUFFETT
Suffix:
Gender:F
Credentials:EDD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22810 SW FOREST CREEK DR UNIT 100
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9694
Mailing Address - Country:US
Mailing Address - Phone:503-707-9010
Mailing Address - Fax:
Practice Address - Street 1:22810 SW FOREST CREEK DR UNIT 100
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9694
Practice Address - Country:US
Practice Address - Phone:503-707-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTSLP1822235Z00000X
OR013343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist