MEDICARE: JESSICA O'NEAL BEASLEY 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	SA17290	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508465345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA O'NEAL BEASLEY CCC-SLP

Provider Business Mailing Address
First Line	:	3309 DEASON AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-3089
Country	:	US
Telephone Number	:	904-616-2549
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 N MARKET ST # 105
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2802
Country	:	US
Telephone Number	:	904-201-2394
Fax Number	:	904-201-2394

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

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/07/2025

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Directions to “ JESSICA O'NEAL BEASLEY CCC-SLP” Practice Location

Language	Start Address	Practice Location

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