Provider Demographics
NPI:1497185615
Name:CECCO, JESSICA LYNNE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:CECCO
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 1:208 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-1117
Mailing Address - Country:US
Mailing Address - Phone:717-386-0911
Mailing Address - Fax:
Practice Address - Street 1:437 PIKETOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9343
Practice Address - Country:US
Practice Address - Phone:717-703-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA36001464A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer