Healthcare Provider Details

I. General information

NPI: 1922875004
Provider Name (Legal Business Name): JESSICA LYNN CHAPPLE
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: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6925 OAKLAND MILLS RD # 206
COLUMBIA MD
21045-4714
US

IV. Provider business mailing address

9471 VOLLMERHAUSEN DR
COLUMBIA MD
21046-2084
US

V. Phone/Fax

Practice location:
  • Phone: 443-864-5647
  • Fax:
Mailing address:
  • Phone: 443-741-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number30373
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: