Provider Demographics
NPI:1255993119
Name:WIMPEL, JESSICA LYNN (MS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:WIMPEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BULLOCKS POINT AVE APT 8A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5327
Mailing Address - Country:US
Mailing Address - Phone:631-873-7669
Mailing Address - Fax:
Practice Address - Street 1:166 BAY SPRING AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1393
Practice Address - Country:US
Practice Address - Phone:401-359-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty