Provider Demographics
NPI:1902115710
Name:MILOT, JESSICA LEE (MS CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:MILOT
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:MILOT
Other - Last Name:HOLST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP/L
Mailing Address - Street 1:40 MINDEN DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1106
Mailing Address - Country:US
Mailing Address - Phone:716-517-5342
Mailing Address - Fax:
Practice Address - Street 1:40 MINDEN DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1106
Practice Address - Country:US
Practice Address - Phone:716-517-5342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2159311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist