Provider Demographics
NPI:1205427226
Name:WETZEL, JESSICA JOAN (M ED)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOAN
Last Name:WETZEL
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JOAN
Other - Last Name:MATHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 FLOYD ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3301
Mailing Address - Country:US
Mailing Address - Phone:646-402-1596
Mailing Address - Fax:
Practice Address - Street 1:175 N. BEACON ST.
Practice Address - Street 2:
Practice Address - City:WATERTWON
Practice Address - State:MA
Practice Address - Zip Code:02472
Practice Address - Country:US
Practice Address - Phone:617-972-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist