Provider Demographics
NPI:1295037224
Name:ROFFER, JESSICA PAHL (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:PAHL
Last Name:ROFFER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3179 BAYSHORE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-4476
Mailing Address - Country:US
Mailing Address - Phone:407-694-8305
Mailing Address - Fax:
Practice Address - Street 1:4443 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6198
Practice Address - Country:US
Practice Address - Phone:727-834-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist