Provider Demographics
NPI:1942582481
Name:SHAMBURGER, JESSICA AUSTIN (MSP)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:AUSTIN
Last Name:SHAMBURGER
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:PAGE
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1607 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1607 WESTBURY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4830
Practice Address - Country:US
Practice Address - Phone:803-359-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSLP.4956SPIN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist