Healthcare Provider Details

I. General information

NPI: 1730014291
Provider Name (Legal Business Name): JESSICA ELIZABETH TOBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W MATTHEWS ST STE 101
MATTHEWS NC
28105-1310
US

IV. Provider business mailing address

211 W MATTHEWS ST STE 101
MATTHEWS NC
28105-1310
US

V. Phone/Fax

Practice location:
  • Phone: 704-846-0262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30005366
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: