Provider Demographics
NPI:1134434392
Name:FLIKSTEEN, JESSICA E (SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:FLIKSTEEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ELIZABETH
Other - Last Name:FLIKKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:264 GOLF LINKS ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-5605
Mailing Address - Country:US
Mailing Address - Phone:094-991-9815
Mailing Address - Fax:
Practice Address - Street 1:264 GOLF LINKS ST
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-5605
Practice Address - Country:US
Practice Address - Phone:094-991-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018518Medicaid
WA600337984Medicare UPIN