Provider Demographics
NPI:1124703772
Name:MARKMAN, JESSICA ROSE (MS CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:MARKMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6942
Mailing Address - Country:US
Mailing Address - Phone:845-820-8967
Mailing Address - Fax:
Practice Address - Street 1:228 WARD ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-1270
Practice Address - Country:US
Practice Address - Phone:845-293-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY034864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist