Randall, Jessica Anne
Randall, Jessica Anne is an individual health care provider with primary practice located at 189 Wheatley Rd , Glen Head NY 11545-2641. She recently has 2 registered licenses in different health care specialties including Speech, Language and Hearing Service Providers / Speech-Language Pathologist, Student, Health Care / Student in an Organized Health Care Education/Training Program. Speech, Language and Hearing Service Providers / Speech-Language Pathologist is her primary health care specialty. Randall, Jessica Anne can be contacted via phone (516) 626-1075.Contact Information
Primary practice address
189 Wheatley Rd
Glen Head NY 11545-2641
Phone: (516) 626-1075
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | ||
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | 029004 | New York |
Profile Details
| NPI number | 1679068829 |
|---|---|
| LBN Legal business name | Randall, Jessica Anne |
| Credentials | MA, CCC-SLP, TSSLD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 28th, 2018 |
| Last updated | Aug 22nd, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679068829 | NPPES |
| New York | MEDICAID | 05979424 |
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