Healthcare Provider Details

I. General information

NPI: 1205603396
Provider Name (Legal Business Name): JESSICA ZIPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W SYBELIA AVE
MAITLAND FL
32751-4739
US

IV. Provider business mailing address

1622 WIND HARBOR RD
BELLE ISLE FL
32809-6844
US

V. Phone/Fax

Practice location:
  • Phone: 407-865-0495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH23717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: