Healthcare Provider Details

I. General information

NPI: 1871429431
Provider Name (Legal Business Name): CRYSTALLEE JESSOP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N 1ST ST STE 3
HAMILTON MT
59840-2141
US

IV. Provider business mailing address

610 N 1ST ST STE 3
HAMILTON MT
59840-2141
US

V. Phone/Fax

Practice location:
  • Phone: 406-381-7786
  • Fax:
Mailing address:
  • Phone: 406-381-7786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-24735
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: