Provider Demographics
NPI:1255614848
Name:TOWNSEND, JESSICA LYNN (ATC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 40TH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1880
Mailing Address - Country:US
Mailing Address - Phone:248-561-8834
Mailing Address - Fax:
Practice Address - Street 1:7274 WARDLEIGH RD BAY J
Practice Address - Street 2:
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-5137
Practice Address - Country:US
Practice Address - Phone:248-561-8834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD03682255A2300X
UT13375815-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer