Provider Demographics
NPI:1619622123
Name:EISKANT, JESSIKA
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:
Last Name:EISKANT
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 1:748 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3036
Mailing Address - Country:US
Mailing Address - Phone:406-465-3280
Mailing Address - Fax:
Practice Address - Street 1:748 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3036
Practice Address - Country:US
Practice Address - Phone:406-465-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical