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General NPI Number Information
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NPI Number | 1114700382
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Entity Type | Individual
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Provider Name | JESSICA LYN POMERVILLE MA-CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 7960 GRAND RIVER AVE STE 280
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City | BRIGHTON
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State | MI
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Zip | 48114
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Country | US
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Telephone | 810-412-4183
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Fax | 810-454-2428
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Provider Business Mailing Address
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Address Line | 9100 LAPEER RD STE C
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City | DAVISON
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State | MI
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Zip | 48423-3620
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Country | US
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Telephone | 810-412-4183
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Fax | 810-309-8635
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101008585
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License Number State | MI
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