Doctor Name: | JESSICA BESTEMAN |
NPI Number: | 1235519091 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 5735 |
Business Practice Address: | 1090 Mountain Valley Rd Edgewood, NM - 870158044 |
Business Phone Number: | 5052818111 |
Business Fax Number: | |
Mailing Address: | Po Box 2225, EDGEWOOD |
State: | NM |
Postal Code: | 870152225 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/05/2015 |
NPI Last Update Date: | 06/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 5735 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |