Healthcare Provider Details

I. General information

NPI: 1972623643
Provider Name (Legal Business Name): JESSICA MARIE BERNATOWICZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ROSE ST
GRAFTON WV
26354-1678
US

IV. Provider business mailing address

16 HEALTHY HEIGHTS VLG
MORGANTOWN WV
26508-8930
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-0095
  • Fax: 304-265-6215
Mailing address:
  • Phone: 304-291-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0970
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: