Individual
JESSICA LYNN CUNNINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
763 JOHNSONBURG RD, SAINT MARYS, PA 15857-3417
(814) 788-8311
Mailing address
1102 WINKLER AVE, KILLEEN, TX 76542-6249
(254) 634-8505
(254) 519-3477
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
106370
TX
235Z00000X
Speech-Language Pathologist
2202005440
VA
235Z00000X
Speech-Language Pathologist
505-SLP
SD
235Z00000X
Speech-Language Pathologist
Primary
PASL007942
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396706065
—
VA
01
—
13967076065
MEDICARE
VA
01
—
192597
BC/BS
VA
Enumeration date
04/17/2008
Last updated
04/29/2022
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