Provider Demographics
NPI:1699969444
Name:BELLOMO, JESSICA MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:BELLOMO
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 1:10077 PINE GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-9071
Mailing Address - Country:US
Mailing Address - Phone:608-628-2405
Mailing Address - Fax:
Practice Address - Street 1:10077 PINE GROVE WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-9071
Practice Address - Country:US
Practice Address - Phone:608-628-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004760A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist