Individual
JESSICA DETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10910 CLARKSVILLE PIKE, ELLICOTT CITY, MD 21042-6106
(410) 313-6600
Mailing address
6823 OLD WATERLOO RD APT 1132, ELKRIDGE, MD 21075-7220
(276) 617-1187
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
01709L
MD
Other
Enumeration date
11/16/2018
Last updated
11/16/2018
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