Provider Demographics
NPI:1750526448
Name:CROSS, JESSICA ROSE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ROSE
Last Name:CROSS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:100 SARATOGA VILLAGE BLVD
Mailing Address - Street 2:SUITE 35
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3737
Mailing Address - Country:US
Mailing Address - Phone:518-899-9235
Mailing Address - Fax:
Practice Address - Street 1:100 SARATOGA VILLAGE BLVD
Practice Address - Street 2:SUITE 35
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-3737
Practice Address - Country:US
Practice Address - Phone:518-899-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014381-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist