Provider Demographics
NPI:1831242825
Name:BRISTOW, JESSICA A (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:BUGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:6225 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-3494
Mailing Address - Country:US
Mailing Address - Phone:205-983-2520
Mailing Address - Fax:
Practice Address - Street 1:6225 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-3494
Practice Address - Country:US
Practice Address - Phone:205-983-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3241235Z00000X
GASLP006836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist