Provider Demographics
NPI:1821356684
Name:LANGEVIN, JESSICA WHITNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:WHITNEY
Last Name:LANGEVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 WESTERN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1390
Mailing Address - Country:US
Mailing Address - Phone:419-423-4994
Mailing Address - Fax:419-423-4110
Practice Address - Street 1:1725 WESTERN AVE STE A
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1390
Practice Address - Country:US
Practice Address - Phone:419-423-4994
Practice Address - Fax:419-423-4110
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61704207Q00000X
MI4301108646207Q00000X
OH35142345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821356684Medicaid