Provider Demographics
NPI:1740454925
Name:CUNNINGHAM, JESSICA LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:CUNNINGHAM
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 1:1102 WINKLER AVE
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6249
Mailing Address - Country:US
Mailing Address - Phone:254-634-8505
Mailing Address - Fax:254-519-3477
Practice Address - Street 1:763 JOHNSONBURG RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3417
Practice Address - Country:US
Practice Address - Phone:814-788-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD505-SLP235Z00000X
TX106370235Z00000X
VA2202005440235Z00000X
PAPASL007942235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA13967076065OtherMEDICARE
VA1396706065Medicaid
VA192597OtherBC/BS