Provider Demographics
NPI:1639396831
Name:RUSH, JESSICA L (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:RUSH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5519 CLAIREMONT MESA BLVD # 428
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2342
Mailing Address - Country:US
Mailing Address - Phone:508-254-2251
Mailing Address - Fax:
Practice Address - Street 1:5945 PACIFIC CENTER BLVD STE 510
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-6305
Practice Address - Country:US
Practice Address - Phone:858-437-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist