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General NPI Number Information
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NPI Number | 1497010482
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Entity Type | Individual
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Provider Name | JESSICA KAE MATTINGLY M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 9000 LAS VEGAS BLVD S UNIT 2035
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City | LAS VEGAS
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State | NV
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Zip | 89123-6406
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Country | US
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Telephone | 615-692-4230
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Fax |
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Provider Business Mailing Address
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Address Line | 425 CLIFTON HEIGHTS DR
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City | LAS VEGAS
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State | NV
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Zip | 89145-4169
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Country | US
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Telephone | 615-692-4230
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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 | 2202009426
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License Number State | VA
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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 | 116827
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License Number State | TX
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Taxonomy #3
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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 | KY
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4775
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 25142
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP-1793
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License Number State | NV
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