Provider Demographics
NPI:1952750697
Name:MUELLER, JESSICA (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BRACEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60407-9779
Mailing Address - Country:US
Mailing Address - Phone:815-210-7493
Mailing Address - Fax:
Practice Address - Street 1:3310 S CENTER ST
Practice Address - Street 2:
Practice Address - City:BRACEVILLE
Practice Address - State:IL
Practice Address - Zip Code:60407-9779
Practice Address - Country:US
Practice Address - Phone:815-210-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic