Provider Demographics
NPI:1831466572
Name:KAJFASZ, JESSICA M (PSYD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:KAJFASZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-9905
Mailing Address - Country:US
Mailing Address - Phone:419-784-1414
Mailing Address - Fax:419-783-2799
Practice Address - Street 1:1400 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-9905
Practice Address - Country:US
Practice Address - Phone:419-784-1414
Practice Address - Fax:419-783-2799
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.7183103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist