MEDICARE: JESSE CARROLL BASS

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	41YS00866100	NJ

General Provider Information

NPI Number	:	1124977269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE CARROLL BASS

Provider Business Mailing Address
First Line	:	106 WOODLAND AVE
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08638-2555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 WOODLAND AVE
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08638-2555
Country	:	US
Telephone Number	:	609-558-0970
Fax Number	:

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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Directions to “ JESSE CARROLL BASS ” Practice Location

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