Provider Demographics
NPI:1467860999
Name:JANSEN, JESSICA (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:JANSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 NORTH MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-3352
Mailing Address - Country:US
Mailing Address - Phone:937-806-0318
Mailing Address - Fax:937-806-0319
Practice Address - Street 1:325 NORTH MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-3352
Practice Address - Country:US
Practice Address - Phone:937-806-0318
Practice Address - Fax:937-806-0319
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer