Individual
MRS. JESSICA I FUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MCD
Contact information
Practice address
81337 OK LN, COVINGTON, LA 70435-8272
(985) 705-6784
Mailing address
81337 OK LN, COVINGTON, LA 70435-8272
(985) 705-6784
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5626
LA
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1714313
—
LA
Enumeration date
05/21/2007
Last updated
03/24/2022
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