Provider Demographics
NPI:1093281107
Name:RUMBAUGH, JESSICA SAMANTHA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SAMANTHA
Last Name:RUMBAUGH
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 1:329 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1412
Mailing Address - Country:US
Mailing Address - Phone:412-474-2023
Mailing Address - Fax:
Practice Address - Street 1:1010 BROADHEAD RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-1510
Practice Address - Country:US
Practice Address - Phone:412-339-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012854101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC012854OtherPROFESSIONAL COUNSELOR LICENSE
OHE.2404109OtherPROFESSIONAL COUNSELOR LICENSE