Provider Demographics
NPI:1043700149
Name:FORREST, JESSIE MICHELLE (SLP-CF)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:MICHELLE
Last Name:FORREST
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205 PRESTON VINEYARD DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6162
Mailing Address - Country:US
Mailing Address - Phone:214-883-2081
Mailing Address - Fax:
Practice Address - Street 1:4500 HILLCREST RD STE 140
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5419
Practice Address - Country:US
Practice Address - Phone:469-331-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist