Provider Demographics
NPI:1881013209
Name:MIER, JESSICA (MA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:MIER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 STECK ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-1105
Mailing Address - Country:US
Mailing Address - Phone:573-318-8983
Mailing Address - Fax:
Practice Address - Street 1:311 STECK ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:MO
Practice Address - Zip Code:63780-1105
Practice Address - Country:US
Practice Address - Phone:573-318-8983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1881013209Medicaid