Healthcare Provider Details

I. General information

NPI: 1275978652
Provider Name (Legal Business Name): JESSICA BOSSOLINA M.S. CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CORNING RD STE 10
CARY NC
27518-9235
US

IV. Provider business mailing address

1801 CREEKVIEW DR
CLAYTON NC
27520-9182
US

V. Phone/Fax

Practice location:
  • Phone: 910-868-6000
  • Fax:
Mailing address:
  • Phone: 908-477-3868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS465800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: