MEDICARE: MISS JEANMARIE DEISSLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	27830773	PA

General Provider Information

NPI Number	:	1033419445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JEANMARIE DEISSLER

Provider Business Mailing Address
First Line	:	3328 ALDINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3802
Country	:	US
Telephone Number	:	267-304-9238
Fax Number	:

Provider Business Practice Location Address
First Line	:	3328 ALDINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3802
Country	:	US
Telephone Number	:	267-304-9238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	11/01/2010

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Directions to “ MISS JEANMARIE DEISSLER ” Practice Location

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