Provider Demographics
NPI:1043808538
Name:HOUSER, JESSICA NOEL
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NOEL
Last Name:HOUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2877 PENNVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-1140
Mailing Address - Country:US
Mailing Address - Phone:484-431-3140
Mailing Address - Fax:
Practice Address - Street 1:2877 PENNVIEW AVE
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-1140
Practice Address - Country:US
Practice Address - Phone:484-431-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional