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General NPI Number Information
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NPI Number | 1245486182
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Entity Type | Individual
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Provider Name | JESSICA BOBERG HARRIS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 910 S WINTERHAWK DR UNIT 101
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-3870
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Country | US
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Telephone | 904-217-7648
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Fax | 352-666-3232
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Provider Business Mailing Address
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Address Line | 910 S WINTERHAWK DR UNIT 101
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-3870
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Country | US
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Telephone | 904-217-7648
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Fax | 352-666-3232
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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 | 225500000X
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Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
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License Number | SA7351
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License Number State | FL
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