Provider Demographics
NPI:1891197554
Name:TIMPE, JESSICA FAITH (MA,CCC,SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FAITH
Last Name:TIMPE
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 1:206 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-1125
Mailing Address - Country:US
Mailing Address - Phone:419-250-2805
Mailing Address - Fax:
Practice Address - Street 1:630 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6314
Practice Address - Country:US
Practice Address - Phone:419-535-0524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP11832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849916Medicaid