Provider Demographics
NPI:1093691404
Name:JESSIE, DALLAS LEI (SLP ASSISTANT)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:LEI
Last Name:JESSIE
Suffix:
Gender:F
Credentials:SLP ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 JAMES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-3122
Mailing Address - Country:US
Mailing Address - Phone:817-910-8131
Mailing Address - Fax:817-616-2713
Practice Address - Street 1:2600 JAMES RD STE 200
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-3122
Practice Address - Country:US
Practice Address - Phone:817-910-8131
Practice Address - Fax:817-616-2713
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX431322355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant