Provider Demographics
NPI:1952978009
Name:KING, JESSICA (HAS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 BROKEN SOUND PKWY NW STE 120
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3638
Mailing Address - Country:US
Mailing Address - Phone:561-367-1623
Mailing Address - Fax:561-299-5438
Practice Address - Street 1:42 BUSINESS CENTRE DR UNIT 304
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-6995
Practice Address - Country:US
Practice Address - Phone:850-837-0497
Practice Address - Fax:561-299-5438
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5576237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist