Provider Demographics
NPI:1710302468
Name:ZAWISKY, JESSICA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ZAWISKY
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 1:16 FARMHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:PA
Mailing Address - Zip Code:17045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 FARMHOUSE LN
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:PA
Practice Address - Zip Code:17045-9113
Practice Address - Country:US
Practice Address - Phone:607-621-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist