Provider Demographics
NPI:1952568404
Name:MUSCIO TRAYLOR, JESSA NICOLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JESSA
Middle Name:NICOLE
Last Name:MUSCIO TRAYLOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:JESSA
Other - Middle Name:NICOLE
Other - Last Name:MUSCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3701 CERRITO AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1763
Mailing Address - Country:US
Mailing Address - Phone:510-232-4036
Mailing Address - Fax:
Practice Address - Street 1:2961 SUMMIT ST
Practice Address - Street 2:SUITE #2
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3482
Practice Address - Country:US
Practice Address - Phone:510-465-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2431231H00000X
CAHA6085231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner