Provider Demographics
NPI:1518219518
Name:SZCZESNY, JESSICA ELLEN (DC, CNIM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELLEN
Last Name:SZCZESNY
Suffix:
Gender:F
Credentials:DC, CNIM
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8749 ASHWORTH DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2269
Mailing Address - Country:US
Mailing Address - Phone:904-673-2857
Mailing Address - Fax:
Practice Address - Street 1:2150 TOWN SQUARE PL
Practice Address - Street 2:SUITE 290
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1465
Practice Address - Country:US
Practice Address - Phone:281-768-6730
Practice Address - Fax:281-768-6766
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
FL246ZE0600X246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic