Healthcare Provider Details

I. General information

NPI: 1205156924
Provider Name (Legal Business Name): JESSICA NORED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 09/21/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 NE 14TH ST
FORT WORTH TX
76164-8901
US

IV. Provider business mailing address

215 NE 14TH ST
FORT WORTH TX
76164-8901
US

V. Phone/Fax

Practice location:
  • Phone: 817-814-2000
  • Fax:
Mailing address:
  • Phone: 817-814-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number105831
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: