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Individual

KIMBERLY JESSUP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
115 LIBERTY ST, BATH, NY 14810-1508
(607) 776-6577
Mailing address
4445 TUCKER RD # A, CAMPBELL, NY 14821-9744

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11252
NY

Other

Enumeration date
10/13/2006
Last updated
07/08/2007
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