| Doctor Name: | MRS. JESSICA ROSE BRADDOCK |
| NPI Number: | 1427181411 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS CCC-SLP |
| License Number: | S3023 |
| Business Practice Address: | 23 Mason St Laurel, MS - 394404437 |
| Business Phone Number: | 6013990539 |
| Business Fax Number: | 6013991617 |
| Mailing Address: | 106 Wildwood Trl, PETAL |
| State: | MS |
| Postal Code: | 394652673 |
| Phone Number: | 6014985591 |
| Fax Number: | |
| NPI Enumeration Date: | 03/13/2007 |
| NPI Last Update Date: | 03/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | S3023 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| 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 |