Healthcare Provider Details

I. General information

NPI: 1538522859
Provider Name (Legal Business Name): ROSALYNN JESSEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 MARYLANE DR
ROGERS AR
72756-6702
US

IV. Provider business mailing address

2403 MARYLANE DR
ROGERS AR
72756-6702
US

V. Phone/Fax

Practice location:
  • Phone: 479-936-1381
  • Fax: 479-631-8993
Mailing address:
  • Phone: 479-936-1381
  • Fax: 479-631-8993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: