Provider Demographics
NPI:1861228553
Name:MCCORMICK, JESSICA ANNA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNA
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 112TH ST SW UNIT J2
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5066
Mailing Address - Country:US
Mailing Address - Phone:407-256-9781
Mailing Address - Fax:
Practice Address - Street 1:112 ANDOVER PARK E
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2915
Practice Address - Country:US
Practice Address - Phone:206-401-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist