Healthcare Provider Details

I. General information

NPI: 1790932416
Provider Name (Legal Business Name): JESSICA WRIGHT M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 MOORES LN
TEXARKANA TX
75503-1858
US

IV. Provider business mailing address

1710 MOORES LN
TEXARKANA TX
75503-1858
US

V. Phone/Fax

Practice location:
  • Phone: 903-794-2705
  • Fax: 903-793-1203
Mailing address:
  • Phone: 903-794-2705
  • Fax: 903-793-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number103565
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: