Healthcare Provider Details

I. General information

NPI: 1669866091
Provider Name (Legal Business Name): JESSICA SUSAN ALLISON CM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 NORTH ST
AUBURN NY
13021
US

IV. Provider business mailing address

17 LANSING STREET ATTN: C. MCLOUD
AUBURN NY
13021-1983
US

V. Phone/Fax

Practice location:
  • Phone: 315-252-5028
  • Fax: 315-252-1587
Mailing address:
  • Phone: 315-567-0455
  • Fax: 315-253-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number001676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: