Healthcare Provider Details

I. General information

NPI: 1780133066
Provider Name (Legal Business Name): JESSICA C NYDAM MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA C BENSON SLP

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 ALDERGROVE AVE
ESCONDIDO CA
92029-1935
US

IV. Provider business mailing address

2310 ALDERGROVE AVE
ESCONDIDO CA
92029-1935
US

V. Phone/Fax

Practice location:
  • Phone: 760-432-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2299
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberRPE 11241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: