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General NPI Number Information
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NPI Number | 1477936912
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Entity Type | Individual
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Provider Name | JESSICA ANN FORTIER-GOSS LADCI
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Gender | Female
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 155 AIRPORT RD
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City | FITCHBURG
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State | MA
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Zip | 01420-8142
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Country | US
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Telephone | 978-343-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 531 LINDELL AVE
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City | LEOMINSTER
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State | MA
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Zip | 01453-5451
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2327
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License Number State | MA
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