Individual
JESSICA TODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
564 RIDGE AVE, LIBERTY, NC 27298-3604
(336) 703-8872
Mailing address
564 RIDGE AVE, LIBERTY, NC 27298-3604
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9547
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9547
SPEECH LANGUAGE PATHOLOGY
NC
Enumeration date
04/11/2018
Last updated
04/11/2018
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