Individual
CARSEN JESSUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
75100 MEDITERRANEAN, PALM DESERT, CA 92211-9069
(760) 837-0033
Mailing address
75100 MEDITERRANEAN, PALM DESERT, CA 92211-9069
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SI60855367
DEPARTMENT OF HEALTH
—
Enumeration date
06/04/2018
Last updated
11/24/2021
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