Provider Demographics
NPI:1609120641
Name:PEIFFER, JESSICA ELLIOTT (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELLIOTT
Last Name:PEIFFER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:165 POWER SPRINGS LOOP
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588
Mailing Address - Country:US
Mailing Address - Phone:610-858-2500
Mailing Address - Fax:
Practice Address - Street 1:699 PRINCE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6622
Practice Address - Country:US
Practice Address - Phone:502-785-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010755235Z00000X
SC7619235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1609120641Medicaid