Provider Demographics
NPI:1598925810
Name:WEICKS, JESSICA (MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WEICKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BUTTERNUT LN
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1096
Mailing Address - Country:US
Mailing Address - Phone:985-674-0357
Mailing Address - Fax:
Practice Address - Street 1:24265 CANE BYU
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-6125
Practice Address - Country:US
Practice Address - Phone:985-869-4183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist