MEDICARE: JESSICA MONSON M.S. 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
1	235Z00000X	Speech-Language Pathologist	1004	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1004	OTHER	NH	SPEECH-LANGUAGE PATHOLOGY LICENSE

General Provider Information

NPI Number	:	1124649009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MONSON M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	18 TURTLE ROCK RD
Second Line	:
City	:	WINDHAM
State	:	NH
Zip	:	03087-2385
Country	:	US
Telephone Number	:	603-275-2317
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 MARY E CLARK DR UNIT 7
Second Line	:
City	:	HAMPSTEAD
State	:	NH
Zip	:	03841-2406
Country	:	US
Telephone Number	:	603-275-2317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2020
Last Update Date	:	05/01/2020

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