Provider Demographics
NPI:1891705810
Name:MATHESON, JESSICA PORTER (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:PORTER
Last Name:MATHESON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFY-SLP
Mailing Address - Street 1:306 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-3153
Mailing Address - Country:US
Mailing Address - Phone:864-885-1423
Mailing Address - Fax:
Practice Address - Street 1:409 E NORTH 1ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2767
Practice Address - Country:US
Practice Address - Phone:864-882-7169
Practice Address - Fax:864-226-2477
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist