Provider Demographics
NPI:1427672724
Name:SYKES, JESICA RENE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESICA
Middle Name:RENE
Last Name:SYKES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 FOLSOM DR APT 241
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7253
Mailing Address - Country:US
Mailing Address - Phone:409-926-1317
Mailing Address - Fax:
Practice Address - Street 1:5550 FOLSOM DR APT 241
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7253
Practice Address - Country:US
Practice Address - Phone:409-926-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty