Provider Demographics
NPI:1861536443
Name:ZIEGLER, JESSICA
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:ZIEGLER
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 1:1502 13TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3825
Mailing Address - Country:US
Mailing Address - Phone:701-651-4325
Mailing Address - Fax:
Practice Address - Street 1:1502 13TH AVE W STE 101
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3825
Practice Address - Country:US
Practice Address - Phone:701-651-4325
Practice Address - Fax:844-787-1839
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND972225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0349336Medicaid