Provider Demographics
NPI:1013342914
Name:DENNISON, JESSICA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NICOLE
Last Name:DENNISON
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 1:19 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40006-1119
Mailing Address - Country:US
Mailing Address - Phone:502-221-5365
Mailing Address - Fax:
Practice Address - Street 1:19 SPRING AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:KY
Practice Address - Zip Code:40006-1119
Practice Address - Country:US
Practice Address - Phone:502-221-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist