Healthcare Provider Details

I. General information

NPI: 1326950866
Provider Name (Legal Business Name): JESSICA MASON MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ASPEN RIDGE SCHOOL RD
ISHPEMING MI
49849-9092
US

IV. Provider business mailing address

73 GRIMES RD
NEGAUNEE MI
49866-9600
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-3175
  • Fax: 906-485-3182
Mailing address:
  • Phone: 906-869-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101003835
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: