MEDICARE: MRS. JESSICA ELIZABETH PEDERSON MS CF/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	103864	TX

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	:	1750543278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA ELIZABETH PEDERSON MS CF/SLP

Provider Business Mailing Address
First Line	:	1906 EL MILENO DRIVE
Second Line	:	SUITE A-103
City	:	PALMHURST
State	:	TX
Zip	:	78573-1223
Country	:	US
Telephone Number	:	956-821-0103
Fax Number	:	956-513-0696

Provider Business Practice Location Address
First Line	:	1906 EL MILENO DR
Second Line	:
City	:	PALMHURST
State	:	TX
Zip	:	78573-1223
Country	:	US
Telephone Number	:	956-821-0103
Fax Number	:	956-513-0696

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	08/08/2022

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