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General NPI Number Information
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NPI Number | 1750520714
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Entity Type | Individual
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Provider Name | JESSICA FITZGERALD M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/16/2009
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Last Update Date | 03/26/2017
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Provider Practice Location Address
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Address Line | 9853 HONEYSUCKLE DR
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City | SEBASTIAN
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State | FL
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Zip | 32976-3319
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Country | US
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Telephone | 772-664-4382
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Fax |
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Provider Business Mailing Address
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Address Line | 5605 MULBERRY LN
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City | GRANT
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State | FL
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Zip | 32949-8022
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Country | US
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Telephone | 772-538-8411
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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 | SA 6880
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License Number State | FL
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