Provider Demographics
NPI:1669960464
Name:PERALTA, JESSI LEIGH (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:LEIGH
Last Name:PERALTA
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42346 LANDING VIEW RD
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-4237
Mailing Address - Country:US
Mailing Address - Phone:985-807-7490
Mailing Address - Fax:
Practice Address - Street 1:2000 COVINGTON CTR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2979
Practice Address - Country:US
Practice Address - Phone:985-464-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4957235Z00000X
LA7723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist