Healthcare Provider Details

I. General information

NPI: 1710167481
Provider Name (Legal Business Name): JESSICA NORRIS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7265 PORTAGE ST NW SUITE B
MASSILLON OH
44646-6101
US

IV. Provider business mailing address

7265 PORTAGE ST NW SUITE B
MASSILLON OH
44646-6101
US

V. Phone/Fax

Practice location:
  • Phone: 330-249-1153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP. 8309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: