Provider Demographics
NPI:1700159449
Name:BLUTSTEIN, JESSICA DANA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANA
Last Name:BLUTSTEIN
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 1:100 CUMMINGS CTR
Mailing Address - Street 2:STE 135C
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6263
Mailing Address - Country:US
Mailing Address - Phone:978-473-7300
Mailing Address - Fax:978-969-0083
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:STE 135C
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6263
Practice Address - Country:US
Practice Address - Phone:978-473-7300
Practice Address - Fax:978-969-0083
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8125235Z00000X
MA948103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist