Provider Demographics
NPI:1881128247
Name:CARRIZO, JESSICA MARIA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:CARRIZO
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 1:2055 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1210
Mailing Address - Country:US
Mailing Address - Phone:707-216-0990
Mailing Address - Fax:
Practice Address - Street 1:2055 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1210
Practice Address - Country:US
Practice Address - Phone:707-216-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2021-04-14
Deactivation Date:2019-07-08
Deactivation Code:
Reactivation Date:2021-04-14
Provider Licenses
StateLicense IDTaxonomies
CA24853235Z00000X
OR15652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist