Healthcare Provider Details

I. General information

NPI: 1720808579
Provider Name (Legal Business Name): JAEDYN WEBSTER MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 OAKHURST DR
CHARLESTON WV
25314-2049
US

IV. Provider business mailing address

3228 PUTNAM AVE
HURRICANE WV
25526-1317
US

V. Phone/Fax

Practice location:
  • Phone: 304-345-8101
  • Fax:
Mailing address:
  • Phone: 770-380-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-2674
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: