Individual
MISS JODY S JESSUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC, RD
Contact information
Practice address
620 N 12TH AVE, STURGEON BAY, WI 54235-1249
(920) 743-9554
Mailing address
620 N 12TH AVE, STURGEON BAY, WI 54235-1249
(920) 743-9554
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43727200
—
WI
Enumeration date
12/14/2007
Last updated
12/14/2007
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