MEDICARE: JESSICA DINSMOOR

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	114617	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629717566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DINSMOOR

Provider Business Mailing Address
First Line	:	6161 WRIGLEY WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6161 WRIGLEY WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3544
Country	:	US
Telephone Number	:	817-814-8500
Fax Number	:

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/31/2022

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Directions to “ JESSICA DINSMOOR ” Practice Location

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