MEDICARE: JESSICA KATHERINE HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA12837	FL

General Provider Information

NPI Number	:	1154037737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KATHERINE HARRIS

Provider Business Mailing Address
First Line	:	3599 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4252
Country	:	US
Telephone Number	:	850-241-8730
Fax Number	:

Provider Business Practice Location Address
First Line	:	4888 BLACKWOOD FOREST DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-2206
Country	:	US
Telephone Number	:	850-241-8730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2023
Last Update Date	:	01/26/2023

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Directions to “ JESSICA KATHERINE HARRIS ” Practice Location

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