Provider Demographics
NPI:1295466431
Name:FRITZSCH, JESSICA DAWN
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:DAWN
Last Name:FRITZSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 POST RD
Mailing Address - Street 2:
Mailing Address - City:SLATE HILL
Mailing Address - State:NY
Mailing Address - Zip Code:10973-3911
Mailing Address - Country:US
Mailing Address - Phone:845-645-6292
Mailing Address - Fax:
Practice Address - Street 1:75 W COMMERCIAL ST STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4799
Practice Address - Country:US
Practice Address - Phone:207-874-1065
Practice Address - Fax:207-874-1068
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist