Provider Demographics
NPI:1841644853
Name:LEVY, JESSICA LEIGH (MCD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:LEVY
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 WILLOW BROOK RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-7884
Mailing Address - Country:US
Mailing Address - Phone:252-452-5009
Mailing Address - Fax:
Practice Address - Street 1:1202 WILLOW BROOK RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-7884
Practice Address - Country:US
Practice Address - Phone:252-452-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist