Provider Demographics
NPI:1760714950
Name:WRIGHT, JESSICA JO (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JO
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JO
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 38118
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-1001
Mailing Address - Country:US
Mailing Address - Phone:704-654-8599
Mailing Address - Fax:980-938-6088
Practice Address - Street 1:11201 LIVINGSTON MILL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4720
Practice Address - Country:US
Practice Address - Phone:704-654-8599
Practice Address - Fax:980-938-6088
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103435235Z00000X
NC11899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist