Individual
JESSICA LYNN COLLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
57 CLAREMONT TER, WAYNE, NJ 07470-5125
(973) 800-3936
Mailing address
57 CLAREMONT TER, WAYNE, NJ 07470-5125
(973) 800-3936
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NJX3HZN15185170
HORIZON BLUE CROSS BLUE SHIELD
NJ
Enumeration date
01/14/2020
Last updated
01/14/2020
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