Basic Information
| Provider Information | |||||||||
| NPI: | 1659851301 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROCK | ||||||||
| FirstName: | JESSICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | MCKEESPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151322806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126736660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3349 WILMINGTON RD | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161051038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245983432 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 02/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 113375 | TX | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SL015642 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.