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General NPI Number Information
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NPI Number | 1669852067
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Entity Type | Individual
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Provider Name | JESSICA ANN AEBI CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 25150 HANCOCK AVE STE 100
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City | MURRIETA
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State | CA
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Zip | 92562-5988
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Country | US
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Telephone | 951-698-7720
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Fax |
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Provider Business Mailing Address
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Address Line | 8703 HIGHWAY 17 BYP S SUITE 1
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City | MYRTLE BEACH
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State | SC
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Zip | 29575-7701
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Country | US
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Telephone | 843-457-1053
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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 | SLP.5742 SPIN
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License Number State | SC
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