Provider Demographics
NPI:1720486764
Name:FETSKO, JAMIE LYNNE (MED)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNNE
Last Name:FETSKO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8586
Mailing Address - Country:US
Mailing Address - Phone:412-364-4348
Mailing Address - Fax:
Practice Address - Street 1:733 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-2939
Practice Address - Country:US
Practice Address - Phone:412-243-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000075103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst