Provider Demographics
NPI:1487279188
Name:LOERA, JESSICA THERESA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:THERESA
Last Name:LOERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 WINDOM WAY
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-2390
Mailing Address - Country:US
Mailing Address - Phone:512-825-3479
Mailing Address - Fax:
Practice Address - Street 1:417 WINDOM WAY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-2390
Practice Address - Country:US
Practice Address - Phone:512-825-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist