Provider Demographics
NPI:1700982626
Name:DEWBERRY, JESSICA RC (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RC
Last Name:DEWBERRY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:RC
Other - Last Name:GIOMPOLETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1500 MUSEUM RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4761
Mailing Address - Country:US
Mailing Address - Phone:501-329-3804
Mailing Address - Fax:501-329-0718
Practice Address - Street 1:1500 MUSEUM RD STE 104
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4761
Practice Address - Country:US
Practice Address - Phone:501-329-3804
Practice Address - Fax:501-329-0718
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1827OtherSLP LICENSE
12040910OtherNATIONAL/ ASHA