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General NPI Number Information
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NPI Number | 1306306675
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Entity Type | Individual
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Provider Name | JESSICA ANN FARRELL MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 1701 N SPRING ST
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City | BEAVER DAM
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State | WI
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Zip | 53916-1178
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Country | US
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Telephone | 920-887-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 400 S TOWNLINE RD
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City | WAUTOMA
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State | WI
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Zip | 54982-6922
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Country | US
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Telephone | 920-787-5514
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 81826-20
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License Number State | WI
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