Provider Demographics
NPI:1184265969
Name:BECKMAN, JESSICA LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:4028 MCCULLOCH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1929
Mailing Address - Country:US
Mailing Address - Phone:218-343-6384
Mailing Address - Fax:
Practice Address - Street 1:10465 E US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:WI
Practice Address - Zip Code:54864-9203
Practice Address - Country:US
Practice Address - Phone:715-364-8465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4902235Z00000X
MN9484235Z00000X
WI1015911682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist