Provider Demographics
NPI:1912321118
Name:ATKINS, JESSICA L (AUD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:ATKINS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:8100 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2900
Mailing Address - Country:US
Mailing Address - Phone:215-535-5598
Mailing Address - Fax:215-331-4208
Practice Address - Street 1:8100 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2900
Practice Address - Country:US
Practice Address - Phone:215-535-5598
Practice Address - Fax:215-331-4208
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006329231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist