Provider Demographics
NPI:1205967114
Name:HOWARD, JESSICA S (SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:S
Last Name:HOWARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 GALINA ST
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-3812
Mailing Address - Country:US
Mailing Address - Phone:501-288-6549
Mailing Address - Fax:501-279-9257
Practice Address - Street 1:242 DUGGER RD
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-3817
Practice Address - Country:US
Practice Address - Phone:501-288-6549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2166235Z00000X
ARSP# 2166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162907321Medicaid
AR162903721Medicaid