Provider Demographics
NPI:1073861902
Name:MOELLER, JESSICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:MOELLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3542
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44309-3542
Mailing Address - Country:US
Mailing Address - Phone:330-996-0347
Mailing Address - Fax:330-996-0359
Practice Address - Street 1:161 N FORGE ST
Practice Address - Street 2:STE 190
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1468
Practice Address - Country:US
Practice Address - Phone:330-375-7285
Practice Address - Fax:330-375-6872
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6977103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist