Provider Demographics
NPI:1780023085
Name:MCCLUNG, JESSICA ANNE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:MCCLUNG
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 1:721 GALVESTON LN KEY WEST
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6407
Mailing Address - Country:US
Mailing Address - Phone:954-559-7987
Mailing Address - Fax:305-390-3044
Practice Address - Street 1:721 GALVESTON LN KEY WEST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6407
Practice Address - Country:US
Practice Address - Phone:954-559-7987
Practice Address - Fax:305-390-3044
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst