Provider Demographics
NPI:1609209204
Name:PERRY, JESSICA K (SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:PERRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:SPECIAL SERVICES
Mailing Address - City:EWING
Mailing Address - State:MO
Mailing Address - Zip Code:63440-0366
Mailing Address - Country:US
Mailing Address - Phone:573-209-3217
Mailing Address - Fax:573-209-3318
Practice Address - Street 1:105 N CLARK
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:MO
Practice Address - Zip Code:63440-0366
Practice Address - Country:US
Practice Address - Phone:573-209-3217
Practice Address - Fax:573-209-3318
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013024926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist