MEDICARE: MS. JESSICA KAE MATTINGLY 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	25142	CA
2	235Z00000X	Speech-Language Pathologist	SP-1793	NV
3	235Z00000X	Speech-Language Pathologist	4775	TN
4	235Z00000X	Speech-Language Pathologist		KY
5	235Z00000X	Speech-Language Pathologist	116827	TX
6	235Z00000X	Speech-Language Pathologist	2202009426	VA

General Provider Information

NPI Number	:	1497010482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA KAE MATTINGLY M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	201 W LANCASTER AVE UNIT 120
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-6664
Country	:	US
Telephone Number	:	615-692-4230
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W LANCASTER AVE UNIT 120
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-6664
Country	:	US
Telephone Number	:	615-692-4230
Fax Number	:

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

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	03/05/2026

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Directions to “ MS. JESSICA KAE MATTINGLY M.S., CCC-SLP” Practice Location

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