Provider Demographics
NPI:1013259795
Name:ELLIOTT, JESSICA ALEXIS
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ALEXIS
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 NW 159TH TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7311
Mailing Address - Country:US
Mailing Address - Phone:405-596-7847
Mailing Address - Fax:
Practice Address - Street 1:2337 NW 159TH TER
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7311
Practice Address - Country:US
Practice Address - Phone:405-596-7847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist