Provider Demographics
NPI:1154745826
Name:OKHOVAT, JESSICA (SLPA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:OKHOVAT
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3916
Mailing Address - Country:US
Mailing Address - Phone:818-383-4912
Mailing Address - Fax:
Practice Address - Street 1:4324 LOUISE AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3916
Practice Address - Country:US
Practice Address - Phone:818-383-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19192355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant