Provider Demographics
NPI:1972803369
Name:BOVA, JESSICA LYNN (MS,CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNN
Last Name:BOVA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:354 ARCHERY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:NEW RINGGOLD
Mailing Address - State:PA
Mailing Address - Zip Code:17960-8520
Mailing Address - Country:US
Mailing Address - Phone:570-640-0227
Mailing Address - Fax:
Practice Address - Street 1:846 E WICONISCO AVE
Practice Address - Street 2:
Practice Address - City:TOWER CITY
Practice Address - State:PA
Practice Address - Zip Code:17980-1609
Practice Address - Country:US
Practice Address - Phone:717-523-1257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist