Provider Demographics
NPI:1508137621
Name:FERNANDEZ, JESSICA (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 UNDERCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1510
Mailing Address - Country:US
Mailing Address - Phone:347-497-3757
Mailing Address - Fax:
Practice Address - Street 1:40 UNDERCLIFF RD
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1510
Practice Address - Country:US
Practice Address - Phone:347-497-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019224235Z00000X
DCSLP000665235Z00000X
VA2202007020235Z00000X
NJ41YS01212700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist