Provider Demographics
NPI:1689189920
Name:FROMUTH, JESSICA SHINN (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SHINN
Last Name:FROMUTH
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:CATHERINE
Other - Last Name:SHINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:162 MAIN ST. #7
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-5716
Mailing Address - Country:US
Mailing Address - Phone:207-776-9673
Mailing Address - Fax:
Practice Address - Street 1:162 MAIN ST. #7
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-5716
Practice Address - Country:US
Practice Address - Phone:207-776-9673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC563171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty