Provider Demographics
NPI:1013280528
Name:LLEWELLYN, JESSICA DOEPPNER
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DOEPPNER
Last Name:LLEWELLYN
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 1:1654 EUCLID ST NW APT 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5634
Mailing Address - Country:US
Mailing Address - Phone:772-485-6770
Mailing Address - Fax:
Practice Address - Street 1:237 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3036
Practice Address - Country:US
Practice Address - Phone:781-433-0672
Practice Address - Fax:781-559-3192
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD282011041C0700X
DCLC500805141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical