Provider Demographics
NPI:1770395634
Name:MISKOWSKY, JESSICA MICHELE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELE
Last Name:MISKOWSKY
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 1:1115 41ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-2407
Mailing Address - Country:US
Mailing Address - Phone:757-755-6555
Mailing Address - Fax:
Practice Address - Street 1:1115 41ST ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-2407
Practice Address - Country:US
Practice Address - Phone:757-755-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty