Individual
MS. JESSICA CANDICE KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD, CCC-SLP
Contact information
Practice address
148 LINWOOD DR, PARAGOULD, AR 72450-4077
(870) 219-1086
Mailing address
PO BOX 573, ASH FLAT, AR 72513
(870) 219-1086
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
924768805
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179755721
—
AR
Enumeration date
03/10/2010
Last updated
04/06/2020
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