Provider Demographics
NPI:1780010777
Name:ROMERO, JESSICA MARIAN (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIAN
Last Name:ROMERO
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIAN
Other - Last Name:YARBROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9040 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4640
Mailing Address - Country:US
Mailing Address - Phone:912-614-1336
Mailing Address - Fax:865-769-0801
Practice Address - Street 1:305 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1409
Practice Address - Country:US
Practice Address - Phone:423-622-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ001678Medicaid