Provider Demographics
NPI:1770196321
Name:TURNER, JESSICA SUE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SUE
Last Name:TURNER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4058 EXPLORATION RD
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-3462
Mailing Address - Country:US
Mailing Address - Phone:716-548-1072
Mailing Address - Fax:
Practice Address - Street 1:4058 EXPLORATION RD
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3462
Practice Address - Country:US
Practice Address - Phone:716-548-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7248OtherSC LABOR LICENSING REGULATION