Healthcare Provider Details

I. General information

NPI: 1346664513
Provider Name (Legal Business Name): JESSICA SYPERT M.A., PSY.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2014
Last Update Date: 02/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 WAGGONER RD
REYNOLDSBURG OH
43068-9707
US

IV. Provider business mailing address

4878 DIERKER RD
COLUMBUS OH
43220-2945
US

V. Phone/Fax

Practice location:
  • Phone: 614-501-5610
  • Fax:
Mailing address:
  • Phone: 614-501-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH3083773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: