Provider Demographics
NPI:1174765051
Name:NEWELL, JESSICA LEE (MS)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LEE
Last Name:NEWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PINE DR
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:13612-2110
Mailing Address - Country:US
Mailing Address - Phone:315-773-5862
Mailing Address - Fax:
Practice Address - Street 1:1635 OHIO ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3032
Practice Address - Country:US
Practice Address - Phone:315-786-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018939-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist