Provider Demographics
NPI:1902419732
Name:HOLLOPETER, JESSALYN ANTOINETTE
Entity Type:Individual
Prefix:
First Name:JESSALYN
Middle Name:ANTOINETTE
Last Name:HOLLOPETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSALYN
Other - Middle Name:ANTOINETTE
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:398 W BAGLEY RD STE 216&16
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1369
Mailing Address - Country:US
Mailing Address - Phone:216-372-7009
Mailing Address - Fax:
Practice Address - Street 1:398 W BAGLEY RD STE 216&16
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1369
Practice Address - Country:US
Practice Address - Phone:216-372-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker