Provider Demographics
NPI:1134368210
Name:DESISTO, JESSICA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DESISTO
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 1:3330 NE 190TH ST APT 2114
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2679
Mailing Address - Country:US
Mailing Address - Phone:774-487-2162
Mailing Address - Fax:
Practice Address - Street 1:3330 NE 190TH ST APT 2114
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2679
Practice Address - Country:US
Practice Address - Phone:774-487-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist