Basic Information
| Provider Information | |||||||||
| NPI: | 1750502027 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUGUSTO | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2609 N DUKE ST | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277043048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192202020 | ||||||||
| FaxNumber: | 9192209257 | ||||||||
| Practice Location | |||||||||
| Address1: | 2609 N DUKE ST | ||||||||
| Address2: | SUITE 801 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277043048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192202020 | ||||||||
| FaxNumber: | 9192209257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 11/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 7325 | NC | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.