Provider Demographics
NPI:1356517460
Name:GIBBONS, JESSICA LYN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYN
Last Name:GIBBONS
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 1:1932 KIRTLEY CT
Mailing Address - Street 2:
Mailing Address - City:BLAKESLEE
Mailing Address - State:PA
Mailing Address - Zip Code:18610-7911
Mailing Address - Country:US
Mailing Address - Phone:570-236-8380
Mailing Address - Fax:570-355-4097
Practice Address - Street 1:2937 ROUTE 611 UNIT 15
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372-6000
Practice Address - Country:US
Practice Address - Phone:570-236-8380
Practice Address - Fax:570-355-4097
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics