MEDICARE: JESSICA HUPP

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	2202010565	VA
2	235Z00000X	Speech-Language Pathologist	04-0000459	DE

General Provider Information

NPI Number	:	1427439496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HUPP

Provider Business Mailing Address
First Line	:	27 HILLCROFT RD
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19711-5559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4413 COX RD
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-3326
Country	:	US
Telephone Number	:	804-406-4322
Fax Number	:

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

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	09/20/2022

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Directions to “ JESSICA HUPP ” Practice Location

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