Provider Demographics
NPI:1558509638
Name:WISSLER, JEANNE M (MSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:M
Last Name:WISSLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SAINT ANDREWS WAY
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-2597
Mailing Address - Country:US
Mailing Address - Phone:603-437-6921
Mailing Address - Fax:
Practice Address - Street 1:17 SAINT ANDREWS WAY
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-2597
Practice Address - Country:US
Practice Address - Phone:603-437-6921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10297191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22382Medicare PIN