Provider Demographics
NPI:1912285347
Name:TODD, JESSICA MAXINE (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MAXINE
Last Name:TODD
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 1:101 E 28TH TER
Mailing Address - Street 2:APT. 9
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3350
Mailing Address - Country:US
Mailing Address - Phone:816-674-7868
Mailing Address - Fax:
Practice Address - Street 1:101 E 28TH TER
Practice Address - Street 2:APT. 9
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-3350
Practice Address - Country:US
Practice Address - Phone:816-674-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009004345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist