Provider Demographics
NPI:1093561318
Name:PRESCOTT, JAKEYSHA TAMARA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAKEYSHA
Middle Name:TAMARA
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 E OCEAN VIEW AVE APT 22
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-2353
Mailing Address - Country:US
Mailing Address - Phone:912-308-7673
Mailing Address - Fax:
Practice Address - Street 1:5417 WESLEYAN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6922
Practice Address - Country:US
Practice Address - Phone:757-490-6672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10133235Z00000X
VA2202008195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist