Provider Demographics
NPI:1205240389
Name:EISENMAN, JESSICA (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EISENMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 OLD FRYBURG RD
Mailing Address - Street 2:
Mailing Address - City:LUCINDA
Mailing Address - State:PA
Mailing Address - Zip Code:16235-2519
Mailing Address - Country:US
Mailing Address - Phone:814-229-7711
Mailing Address - Fax:814-297-0999
Practice Address - Street 1:22868 ROUTE 68
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214
Practice Address - Country:US
Practice Address - Phone:814-297-0998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional