Provider Demographics
NPI:1770606188
Name:ANSON, JESSICA JANELLE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JANELLE
Last Name:ANSON
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 1:2022 WEDDINGTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-8743
Mailing Address - Country:US
Mailing Address - Phone:704-846-2773
Mailing Address - Fax:
Practice Address - Street 1:2022 WEDDINGTON LAKE DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-8743
Practice Address - Country:US
Practice Address - Phone:704-846-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007741235Z00000X
NC8153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist