Provider Demographics
NPI:1649615352
Name:JESSICA TOWLE SLP
Entity type:Organization
Organization Name:JESSICA TOWLE SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOWLE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:982-814-6428
Mailing Address - Street 1:2505 LACORTE PL
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-8866
Mailing Address - Country:US
Mailing Address - Phone:928-814-6428
Mailing Address - Fax:
Practice Address - Street 1:2505 LACORTE PL
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-8866
Practice Address - Country:US
Practice Address - Phone:928-814-6428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty