Provider Demographics
NPI:1346073947
Name:RUCKER, JESSIKA MAYA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSIKA
Middle Name:MAYA
Last Name:RUCKER
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 1:4682 PERRY MILL CIR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5321
Mailing Address - Country:US
Mailing Address - Phone:706-836-1818
Mailing Address - Fax:
Practice Address - Street 1:2601 NETWORK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9092
Practice Address - Country:US
Practice Address - Phone:706-836-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist