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Individual
JESSICA ANNE RANDALL
Active
Individual
JESSICA ANNE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP, TSSLD
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
029004
NY
235Z00000X
Speech-Language Pathologist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05979424
—
NY
Enumeration date
06/28/2018
Last updated
06/07/2025
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