Provider Demographics
NPI:1780701904
Name:SZUSH, JESSICA T (MCD CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:T
Last Name:SZUSH
Suffix:
Gender:F
Credentials:MCD CCCSLP
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:SZUSH
Other - Last Name:GRANIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MCD CCCSLP
Mailing Address - Street 1:645 FAIRWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301
Mailing Address - Country:US
Mailing Address - Phone:985-688-5773
Mailing Address - Fax:985-872-3205
Practice Address - Street 1:620 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-872-3285
Practice Address - Fax:985-872-3205
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1475998Medicaid
LA1475998Medicaid