Provider Demographics
NPI:1134855539
Name:WITMER, JESSICA JOY
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOY
Last Name:WITMER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W GALE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1831
Mailing Address - Country:US
Mailing Address - Phone:260-348-7688
Mailing Address - Fax:
Practice Address - Street 1:7230 ENGLE RD STE 305
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2227
Practice Address - Country:US
Practice Address - Phone:260-203-4996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health