Healthcare Provider Details

I. General information

NPI: 1811813892
Provider Name (Legal Business Name): JENSON GRACE MUSKOVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CHESTNUT ST STE 7
ANDOVER MA
01810-3724
US

IV. Provider business mailing address

103 9TH ST APT 213
CHARLESTOWN MA
02129-4202
US

V. Phone/Fax

Practice location:
  • Phone: 978-296-4486
  • Fax:
Mailing address:
  • Phone: 214-385-6358
  • Fax:

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: