Provider Demographics
NPI:1881449395
Name:HAUSER, JESSICA (ATR-BC, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HAUSER
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:KUNKLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18058-0412
Mailing Address - Country:US
Mailing Address - Phone:267-601-4326
Mailing Address - Fax:
Practice Address - Street 1:236 SMITH GAP TERRACE
Practice Address - Street 2:
Practice Address - City:KUNKLETOWN
Practice Address - State:PA
Practice Address - Zip Code:18058
Practice Address - Country:US
Practice Address - Phone:267-601-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15580101YA0400X
PA19-573221700000X
PAPC013777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist