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General NPI Number Information
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NPI Number | 1164014965
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Entity Type | Individual
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Provider Name | JESSIE JOLLY M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 255 W LEBANON STE 312
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City | FRISCO
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State | TX
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Zip | 75036-3415
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Country | US
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Telephone | 817-479-7019
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Fax |
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Provider Business Mailing Address
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Address Line | 9655 WHARF RD APT 331
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City | COPPELL
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State | TX
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Zip | 75019-5843
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Country | US
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Telephone | 817-676-1434
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Fax |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 114841
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License Number State | TX
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