Provider Demographics
NPI:1720830037
Name:JESTER, AVERY GRACE (CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:AVERY
Middle Name:GRACE
Last Name:JESTER
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 E 107TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2235
Mailing Address - Country:US
Mailing Address - Phone:216-791-2196
Mailing Address - Fax:
Practice Address - Street 1:2181 AMBLESIDE DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4645
Practice Address - Country:US
Practice Address - Phone:216-791-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program