Provider Demographics
NPI:1982957908
Name:WETHERBEE, JESSICA (MS, CGC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WETHERBEE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WETHERBEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:3031 W GRAND BLVD
Mailing Address - Street 2:NCO-7
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3046
Mailing Address - Country:US
Mailing Address - Phone:313-916-4310
Mailing Address - Fax:
Practice Address - Street 1:3031 W GRAND BLVD
Practice Address - Street 2:NCO-7
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3046
Practice Address - Country:US
Practice Address - Phone:313-916-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS