Provider Demographics
NPI:1700625431
Name:PELL, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W. OFFICE CENTER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034
Mailing Address - Country:US
Mailing Address - Phone:484-464-7134
Mailing Address - Fax:
Practice Address - Street 1:500 W. OFFICE CENTER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034
Practice Address - Country:US
Practice Address - Phone:484-464-7134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health