Provider Demographics
NPI:1952594061
Name:STOVER, JESSICA DRISCOLL (MA,CCC/SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DRISCOLL
Last Name:STOVER
Suffix:
Gender:F
Credentials:MA,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3881 N URBANA LISBON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45369-8568
Mailing Address - Country:US
Mailing Address - Phone:937-828-0028
Mailing Address - Fax:
Practice Address - Street 1:5045 N MAIN ST
Practice Address - Street 2:SUITE350
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3698
Practice Address - Country:US
Practice Address - Phone:937-276-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist