MEDICARE: JESSICA WEBSTER LLC

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	251S00000X	Community/Behavioral Health Agency	PC004174	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1295910693	OTHER	PA	NPI 1

General Provider Information

NPI Number	:	1124558358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA WEBSTER LLC

Provider Business Mailing Address
First Line	:	4003 1ST AVE STE A
Second Line	:
City	:	LAFAYETTE HILL
State	:	PA
Zip	:	19444-1401
Country	:	US
Telephone Number	:	267-973-7529
Fax Number	:

Provider Business Practice Location Address
First Line	:	4003 1ST AVE STE A
Second Line	:
City	:	LAFAYETTE HILL
State	:	PA
Zip	:	19444-1401
Country	:	US
Telephone Number	:	267-973-7529
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	JESSICA L WEBSTER
Credential	:	LPC
Telephone Number	:	267-973-7529

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	07/21/2022

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Directions to “JESSICA WEBSTER LLC ” Practice Location

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