Provider Demographics
NPI:1427331578
Name:OTTO, JESSICA BETH (CFY-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BETH
Last Name:OTTO
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:BETH
Other - Last Name:SALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11512 LAKE MEAD AVE
Mailing Address - Street 2:SUITE 604
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9680
Mailing Address - Country:US
Mailing Address - Phone:904-652-5408
Mailing Address - Fax:877-652-5052
Practice Address - Street 1:11512 LAKE MEAD AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9680
Practice Address - Country:US
Practice Address - Phone:904-652-5408
Practice Address - Fax:877-652-5052
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist