Provider Demographics
NPI:1851534093
Name:ELMORE, JESSENA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSENA
Middle Name:
Last Name:ELMORE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 ALMEDA RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7434
Mailing Address - Country:US
Mailing Address - Phone:713-533-9826
Mailing Address - Fax:713-533-9828
Practice Address - Street 1:5445 ALMEDA RD
Practice Address - Street 2:SUITE 222
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7434
Practice Address - Country:US
Practice Address - Phone:713-533-9826
Practice Address - Fax:713-533-9828
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204604701Medicaid