Provider Demographics
NPI:1255908356
Name:HAYWORTH, JESSICA (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HAYWORTH
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 OLYMPIC WAY
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1482
Mailing Address - Country:US
Mailing Address - Phone:330-212-7496
Mailing Address - Fax:
Practice Address - Street 1:707 OLYMPIC WAY
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1482
Practice Address - Country:US
Practice Address - Phone:330-212-7496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist