Provider Demographics
NPI:1053048991
Name:CHEN, JESSICA (AUD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4056
Mailing Address - Country:US
Mailing Address - Phone:813-265-2255
Mailing Address - Fax:813-265-3355
Practice Address - Street 1:700 SE 5TH TER STE 11
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4877
Practice Address - Country:US
Practice Address - Phone:352-795-5700
Practice Address - Fax:352-795-8663
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2645231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist