Healthcare Provider Details

I. General information

NPI: 1679447601
Provider Name (Legal Business Name): JESSIE ANNE MUNSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 BLUEBONNET BLVD STE B
BATON ROUGE LA
70810-2982
US

IV. Provider business mailing address

1867 MARILYN DR
BATON ROUGE LA
70815-4939
US

V. Phone/Fax

Practice location:
  • Phone: 225-242-9217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1706
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: