Provider Demographics
NPI:1942937545
Name:MARKS, JESSICA (MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4548 ROUTE 419
Mailing Address - Street 2:
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-8000
Mailing Address - Country:US
Mailing Address - Phone:717-926-0444
Mailing Address - Fax:
Practice Address - Street 1:1718 GRACE AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-1507
Practice Address - Country:US
Practice Address - Phone:717-926-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health