Provider Demographics
NPI:1982903027
Name:JESSEN, NICOLE RUTH (MS, ATC, LAT, PES)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:RUTH
Last Name:JESSEN
Suffix:
Gender:F
Credentials:MS, ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 ELMONT RD APT 2
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1478
Mailing Address - Country:US
Mailing Address - Phone:440-554-9285
Mailing Address - Fax:
Practice Address - Street 1:2830 NAPOLEON RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9814
Practice Address - Country:US
Practice Address - Phone:419-559-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.003428172V00000X
TXAT92792255A2300X
OHAT0034282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No172V00000XOther Service ProvidersCommunity Health Worker