Provider Demographics
NPI:1518075316
Name:ELLIOTT, JESSICA L (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:ELLIOTT
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 1:107 E HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MO
Mailing Address - Zip Code:65236
Mailing Address - Country:US
Mailing Address - Phone:660-548-1212
Mailing Address - Fax:660-548-1023
Practice Address - Street 1:107 E HARRISON ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:MO
Practice Address - Zip Code:65236
Practice Address - Country:US
Practice Address - Phone:660-548-1212
Practice Address - Fax:660-548-1023
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003015508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist