Provider Demographics
NPI:1851786198
Name:FAUGHT, JESSLYNN LANDEL (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSLYNN
Middle Name:LANDEL
Last Name:FAUGHT
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1311
Mailing Address - Country:US
Mailing Address - Phone:205-638-7501
Mailing Address - Fax:205-638-2077
Practice Address - Street 1:1208 3RD AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1311
Practice Address - Country:US
Practice Address - Phone:205-638-7501
Practice Address - Fax:205-638-2077
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist