Healthcare Provider Details

I. General information

NPI: 1891271565
Provider Name (Legal Business Name): JESSICA LEE STEVENSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 S HIGHWAY 27 STE 4
SOMERSET KY
42501-3124
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9058
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-1815
  • Fax:
Mailing address:
  • Phone: 419-695-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: