Provider Demographics
NPI:1417648809
Name:LEGETTE, JIMMERE L
Entity Type:Individual
Prefix:
First Name:JIMMERE
Middle Name:L
Last Name:LEGETTE
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 1:5504 WOODMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3320
Mailing Address - Country:US
Mailing Address - Phone:443-490-2091
Mailing Address - Fax:
Practice Address - Street 1:5504 WOODMONT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3320
Practice Address - Country:US
Practice Address - Phone:443-490-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician