Provider Demographics
NPI:1669949012
Name:HYDE, JESSICA ROSE (AUD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:HYDE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MORGAN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4819
Mailing Address - Country:US
Mailing Address - Phone:510-418-3345
Mailing Address - Fax:
Practice Address - Street 1:3333 MENDOCINO AVE STE 115
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3631
Practice Address - Country:US
Practice Address - Phone:707-566-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3377237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter