Healthcare Provider Details

I. General information

NPI: 1003987488
Provider Name (Legal Business Name): JESSICA M FLEEGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 JACKSON ST
REYNOLDSVILLE PA
15851-1354
US

IV. Provider business mailing address

522 JACKSON ST
REYNOLDSVILLE PA
15851-1354
US

V. Phone/Fax

Practice location:
  • Phone: 814-653-9428
  • Fax:
Mailing address:
  • Phone: 814-653-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004219
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: