Provider Demographics
NPI:1669852067
Name:AEBI, JESSICA ANN (CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ANN
Last Name:AEBI
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8703 HIGHWAY 17 BYP S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-7701
Mailing Address - Country:US
Mailing Address - Phone:843-457-1053
Mailing Address - Fax:
Practice Address - Street 1:25150 HANCOCK AVE STE 100
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5988
Practice Address - Country:US
Practice Address - Phone:951-698-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSLP.5742 SPIN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist