Provider Demographics
NPI:1689877516
Name:SWISEGOOD, JESSICA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SWISEGOOD
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:PO BOX 7002
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAKE ESTATES
Mailing Address - State:FL
Mailing Address - Zip Code:33855-7002
Mailing Address - Country:US
Mailing Address - Phone:217-502-7951
Mailing Address - Fax:
Practice Address - Street 1:7151 RED GRANGE BLVD
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE ESTATES
Practice Address - State:FL
Practice Address - Zip Code:33855
Practice Address - Country:US
Practice Address - Phone:217-502-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist