Provider Demographics
NPI:1922538669
Name:TUMOLILLO, JESSICA LYNN (AUD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:TUMOLILLO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5356 REYNOLDS ST STE 505
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6017
Mailing Address - Country:US
Mailing Address - Phone:912-356-1515
Mailing Address - Fax:912-644-0756
Practice Address - Street 1:5356 REYNOLDS ST STE 505
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6017
Practice Address - Country:US
Practice Address - Phone:912-356-1515
Practice Address - Fax:912-644-0756
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81122231H00000X
GAAUD004088231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAUD004088OtherSTATE LICENSE