Provider Demographics
NPI:1437632668
Name:ATALLAH, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ATALLAH
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 1:1842 REED AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5445
Mailing Address - Country:US
Mailing Address - Phone:919-257-1867
Mailing Address - Fax:
Practice Address - Street 1:5703 OBERLIN DR
Practice Address - Street 2:STE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1743
Practice Address - Country:US
Practice Address - Phone:760-205-1011
Practice Address - Fax:844-308-5802
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003208235Z00000X
CA12990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist