Healthcare Provider Details

I. General information

NPI: 1619252970
Provider Name (Legal Business Name): JESSICA L ZDATNY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 E BASIN RD COLONIAL SCHOOL DISTRICT
NEW CASTLE DE
19720-4214
US

IV. Provider business mailing address

555 HYETTS CORNER RD COST RECOVERY
MIDDLETOWN DE
19709-8907
US

V. Phone/Fax

Practice location:
  • Phone: 302-323-2700
  • Fax:
Mailing address:
  • Phone: 302-449-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number59777
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: