Healthcare Provider Details

I. General information

NPI: 1982984233
Provider Name (Legal Business Name): JESSICA LEE BUDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NW 4TH ST
BOCA RATON FL
33432-3826
US

IV. Provider business mailing address

12934 CLIFTON DR
BOCA RATON FL
33428-4774
US

V. Phone/Fax

Practice location:
  • Phone: 561-391-8444
  • Fax:
Mailing address:
  • Phone: 561-213-7561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ5419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: