Provider Demographics
NPI:1326547423
Name:WAHL, JESSICA RAE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:WAHL
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 1:5863 NW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1483
Mailing Address - Country:US
Mailing Address - Phone:816-984-8282
Mailing Address - Fax:
Practice Address - Street 1:5863 NW 72ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1483
Practice Address - Country:US
Practice Address - Phone:816-984-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician