Provider Demographics
NPI:1356606610
Name:BLAHA, JESSICA JENELLE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JENELLE
Last Name:BLAHA
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 1:10639 GRANT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1281
Mailing Address - Country:US
Mailing Address - Phone:440-667-3832
Mailing Address - Fax:
Practice Address - Street 1:10639 GRANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1281
Practice Address - Country:US
Practice Address - Phone:440-667-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist