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General NPI Number Information
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NPI Number | 1124558358
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Entity Type | Organization
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Legal Business Name | JESSICA WEBSTER LLC
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4003 1ST AVE STE A
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City | LAFAYETTE HILL
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State | PA
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Zip | 19444-1401
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Country | US
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Telephone | 267-973-7529
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Fax |
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Provider Business Mailing Address
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Address Line | 4003 1ST AVE STE A
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City | LAFAYETTE HILL
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State | PA
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Zip | 19444-1401
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Country | US
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Telephone | 267-973-7529
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | JESSICA L WEBSTER
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Credential | LPC
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Telephone | 267-973-7529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PC004174
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License Number State | PA
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