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NPI Code Detail

MEDICARE: MRS. JESSICA CANTRELLE CCC-SLP

MEDICARE:  MRS. JESSICA  CANTRELLE  CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist4713LA

General Provider Information

NPI Number : 1063591253
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA CANTRELLE CCC-SLP
Provider Business Mailing Address
First Line : P.O. BOX DRAWER 520
Second Line :
City : ABBEVILLE
State : LA
Zip : 70511
Country : US
Telephone Number : 337-581-0133
Fax Number :
Provider Business Practice Location Address
First Line : 2910 AMBASSADOR CAFFERY PKWY
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-6756
Country : US
Telephone Number : 337-521-7790
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 09/12/2025

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Directions to “ MRS. JESSICA CANTRELLE CCC-SLP” Practice Location

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