Provider Demographics
NPI:1902171036
Name:FOLTZ, JESSIE M (MS)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:M
Last Name:FOLTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4890
Mailing Address - Country:US
Mailing Address - Phone:603-672-5005
Mailing Address - Fax:603-672-6501
Practice Address - Street 1:16 ELM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4890
Practice Address - Country:US
Practice Address - Phone:603-672-5005
Practice Address - Fax:603-672-6501
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1144101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health