Healthcare Provider Details

I. General information

NPI: 1750543278
Provider Name (Legal Business Name): JESSICA ELIZABETH PEDERSON MS CF/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 EL MILENO DR
PALMHURST TX
78573-1223
US

IV. Provider business mailing address

1906 EL MILENO DRIVE SUITE A-103
PALMHURST TX
78573-1223
US

V. Phone/Fax

Practice location:
  • Phone: 956-821-0103
  • Fax: 956-513-0696
Mailing address:
  • Phone: 956-821-0103
  • Fax: 956-513-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number103864
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: