Healthcare Provider Details

I. General information

NPI: 1750793006
Provider Name (Legal Business Name): JESSICA MARIE GAGE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAPLE DR STE A
WEXFORD PA
15090-8327
US

IV. Provider business mailing address

30 MAPLE DR STE A
WEXFORD PA
15090-8327
US

V. Phone/Fax

Practice location:
  • Phone: 724-207-3767
  • Fax:
Mailing address:
  • Phone: 724-207-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007550
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: