Provider Demographics
NPI:1841781077
Name:LATTUS, JESSICA (SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LATTUS
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 1:145 KENNEDY DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3341
Mailing Address - Country:US
Mailing Address - Phone:731-281-4407
Mailing Address - Fax:731-588-5739
Practice Address - Street 1:145 KENNEDY DR STE B
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3341
Practice Address - Country:US
Practice Address - Phone:731-281-4407
Practice Address - Fax:731-588-5739
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist