Provider Demographics
NPI:1912675182
Name:LAFONTAINE, JESSICA ELLEN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELLEN
Last Name:LAFONTAINE
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 1:16169 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9527
Mailing Address - Country:US
Mailing Address - Phone:567-207-4225
Mailing Address - Fax:
Practice Address - Street 1:16169 BEECHWOOD RD
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-9527
Practice Address - Country:US
Practice Address - Phone:567-207-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health