Healthcare Provider Details

I. General information

NPI: 1417788258
Provider Name (Legal Business Name): JESSICA NICOLE POLLIHAN M.S. CCC- SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 MARBACH DR
WASHINGTON MO
63090-4636
US

IV. Provider business mailing address

3212 RINGER RD
SAINT LOUIS MO
63125-5539
US

V. Phone/Fax

Practice location:
  • Phone: 163-639-2402
  • Fax:
Mailing address:
  • Phone:
  • 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: