Provider Demographics
NPI:1710591730
Name:BERRY, JESSICA LENA (MS, CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LENA
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-1129
Mailing Address - Country:US
Mailing Address - Phone:276-728-2382
Mailing Address - Fax:
Practice Address - Street 1:1036 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-1129
Practice Address - Country:US
Practice Address - Phone:276-728-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist