Provider Demographics
NPI:1770253502
Name:TUCKER, JESSICA MORGAN (MM, MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MORGAN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MM, 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 1:3001 S CREASY LN STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5206
Mailing Address - Country:US
Mailing Address - Phone:765-423-6885
Mailing Address - Fax:
Practice Address - Street 1:3001 S CREASY LN STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5206
Practice Address - Country:US
Practice Address - Phone:765-423-6885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007871A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist