Provider Demographics
NPI:1427316561
Name:FOSS, JESSICA L (SAS1879)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:FOSS
Suffix:
Gender:F
Credentials:SAS1879
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 LEARNERS LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:ME
Mailing Address - Zip Code:04950-1323
Mailing Address - Country:US
Mailing Address - Phone:207-696-4911
Mailing Address - Fax:
Practice Address - Street 1:43 LEARNERS LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:ME
Practice Address - Zip Code:04950-1323
Practice Address - Country:US
Practice Address - Phone:207-696-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESAS128792355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant