Provider Demographics
NPI:1912602459
Name:MATRONE, JESSICA GRACE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRACE
Last Name:MATRONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 POST RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-4124
Mailing Address - Country:US
Mailing Address - Phone:401-952-4192
Mailing Address - Fax:
Practice Address - Street 1:166 BAY SPRING AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1393
Practice Address - Country:US
Practice Address - Phone:401-359-4898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist