Provider Demographics
NPI:1467189282
Name:CHESEBRO, JILLIAN MARY
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARY
Last Name:CHESEBRO
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 1:3379 STATE HIGHWAY 220
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-3705
Mailing Address - Country:US
Mailing Address - Phone:607-793-1181
Mailing Address - Fax:
Practice Address - Street 1:122 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6321
Practice Address - Country:US
Practice Address - Phone:315-732-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician