Healthcare Provider Details

I. General information

NPI: 1427672724
Provider Name (Legal Business Name): JESICA RENE SYKES MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 FOLSOM DR APT 241
BEAUMONT TX
77706-7253
US

IV. Provider business mailing address

5550 FOLSOM DR APT 241
BEAUMONT TX
77706-7253
US

V. Phone/Fax

Practice location:
  • Phone: 409-926-1317
  • Fax:
Mailing address:
  • Phone: 409-926-1317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number115769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: