Provider Demographics
NPI:1104286913
Name:COX, JESSICA RENEE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:COX
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 1:1915 BOLEN RD
Mailing Address - Street 2:
Mailing Address - City:JUMPING BRANCH
Mailing Address - State:WV
Mailing Address - Zip Code:25969-9533
Mailing Address - Country:US
Mailing Address - Phone:304-921-0537
Mailing Address - Fax:
Practice Address - Street 1:1915 BOLEN RD
Practice Address - Street 2:
Practice Address - City:JUMPING BRANCH
Practice Address - State:WV
Practice Address - Zip Code:25969-9533
Practice Address - Country:US
Practice Address - Phone:304-921-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
WVSLP-1711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist