Healthcare Provider Details

I. General information

NPI: 1255294799
Provider Name (Legal Business Name): JESSICA LYNN TRAUTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 DUNCAN DR
PROVIDENCE RI
02906-7003
US

IV. Provider business mailing address

51 OTTAWA ST APT 1
WEST WARWICK RI
02893-5076
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-9045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: