Healthcare Provider Details

I. General information

NPI: 1699340174
Provider Name (Legal Business Name): TESSA JAZDZYK MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 COUNTY ROAD HQ # 200
MARQUETTE MI
49855-8855
US

IV. Provider business mailing address

11253 PATTERSON RD
RAVENNA MI
49451-9560
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-5900
  • Fax:
Mailing address:
  • Phone: 231-740-7540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14360811
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14360811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: