Provider Demographics
NPI:1841496494
Name:BUCHANAN, JESSICA A (MS-CCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MS-CCC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:HARGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-CEY
Mailing Address - Street 1:3122 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4004
Mailing Address - Country:US
Mailing Address - Phone:937-299-9337
Mailing Address - Fax:937-299-9227
Practice Address - Street 1:3122 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4004
Practice Address - Country:US
Practice Address - Phone:937-299-9337
Practice Address - Fax:937-299-9227
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2367282Medicaid
OH2367282Medicaid