Provider Demographics
NPI:1427331578
Name:OTTO, JESSICA BETH (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BETH
Last Name:OTTO
Suffix:
Gender:F
Credentials:CCC-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 1:13475 ATLANTIC BLVD SUITE 8
Mailing Address - Street 2:#874
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225
Mailing Address - Country:US
Mailing Address - Phone:904-254-8713
Mailing Address - Fax:
Practice Address - Street 1:13475 ATLANTIC BLVD STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3290
Practice Address - Country:US
Practice Address - Phone:904-254-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist