Provider Demographics
NPI:1831412675
Name:FIEO, JESSICA (LAC,LOM,)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FIEO
Suffix:
Gender:F
Credentials:LAC,LOM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 BECHTEL RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2829
Mailing Address - Country:US
Mailing Address - Phone:610-906-0400
Mailing Address - Fax:610-489-9095
Practice Address - Street 1:169 BECHTEL RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2829
Practice Address - Country:US
Practice Address - Phone:610-906-0400
Practice Address - Fax:610-489-9095
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000083171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist