Provider Demographics
NPI:1760948970
Name:POIRIER, JESSICA RUTH (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RUTH
Last Name:POIRIER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:RUTH
Other - Last Name:VANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 DARLING WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-2084
Mailing Address - Country:US
Mailing Address - Phone:401-595-6164
Mailing Address - Fax:
Practice Address - Street 1:160 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-4037
Practice Address - Country:US
Practice Address - Phone:508-660-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist