Healthcare Provider Details

I. General information

NPI: 1417560814
Provider Name (Legal Business Name): JESSICA STONE HULGAN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ELIZABETH STONE

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3074 HICKORY VALLEY RD
CHATTANOOGA TN
37421-1273
US

IV. Provider business mailing address

5819 WINDING LN STE 105
HIXSON TN
37343-4067
US

V. Phone/Fax

Practice location:
  • Phone: 423-622-1551
  • Fax:
Mailing address:
  • Phone: 423-877-5042
  • Fax: 423-877-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7239
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: