Provider Demographics
NPI:1659057883
Name:ANNESE, JAILYN MARIE (BS)
Entity Type:Individual
Prefix:MS
First Name:JAILYN
Middle Name:MARIE
Last Name:ANNESE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 HELO CT
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8062
Mailing Address - Country:US
Mailing Address - Phone:603-305-7203
Mailing Address - Fax:
Practice Address - Street 1:1543 HELO CT
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8062
Practice Address - Country:US
Practice Address - Phone:603-305-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY41967222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer