Provider Demographics
NPI:1255380135
Name:ESSICK, JACQUELINE PATRICIA (CCCSLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:PATRICIA
Last Name:ESSICK
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-7123
Mailing Address - Country:US
Mailing Address - Phone:336-249-8249
Mailing Address - Fax:336-249-8249
Practice Address - Street 1:1910 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-7123
Practice Address - Country:US
Practice Address - Phone:336-249-8249
Practice Address - Fax:336-249-8249
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411078Medicaid
NC128UWOtherBCBS OF NC