Provider Demographics
NPI:1588969554
Name:ROSS, JESSICA (A-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:A-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 TROUP HWY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2356
Mailing Address - Country:US
Mailing Address - Phone:903-939-2800
Mailing Address - Fax:903-581-7057
Practice Address - Street 1:4801 TROUP HWY
Practice Address - Street 2:SUITE 800
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2356
Practice Address - Country:US
Practice Address - Phone:903-939-2800
Practice Address - Fax:903-581-7057
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1064372355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207164901Medicaid
TX149984001Medicaid
TX676535Medicare PIN
TX456606Medicare PIN