Individual
JESSICA STANNARD-BACKUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2841 THOUSAND ACRES RD, DELANSON, NY 12053-1917
(518) 875-6141
Mailing address
2841 THOUSAND ACRES RD, DELANSON, NY 12053-1917
(518) 875-6141
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
125039-01
NY
101YM0800X
Mental Health Counselor
—
NY
Other
Enumeration date
09/10/2024
Last updated
12/03/2024
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