Provider Demographics
NPI:1205102027
Name:CAWBY, JESSICA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CAWBY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S CULLEN ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-3144
Mailing Address - Country:US
Mailing Address - Phone:765-427-5664
Mailing Address - Fax:
Practice Address - Street 1:3741 ROME DR STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4490
Practice Address - Country:US
Practice Address - Phone:765-250-3662
Practice Address - Fax:765-250-5079
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004692A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist