Provider Demographics
NPI:1376528885
Name:JESSOP, MARGARET ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:JESSOP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53700 GENERATIONS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1539
Mailing Address - Country:US
Mailing Address - Phone:574-235-3026
Mailing Address - Fax:
Practice Address - Street 1:53700 GENERATIONS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1539
Practice Address - Country:US
Practice Address - Phone:574-235-3026
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18255103TC2200X
IN20041913A103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent