1104105196 NPI number — MRS. JESSICA D MCGLONE M.ED., LPCC, NCC

Table of content: MRS. JESSICA D MCGLONE M.ED., LPCC, NCC (NPI 1104105196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104105196 NPI number — MRS. JESSICA D MCGLONE M.ED., LPCC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGLONE
Provider First Name:
JESSICA
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPCC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAYLESS
Provider Other First Name:
JESSICA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104105196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOREHEAD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40351-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-291-3355
Provider Business Mailing Address Fax Number:
502-331-6062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
174 CHRISTY CRK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-9658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-291-3355
Provider Business Practice Location Address Fax Number:
502-331-6062
Provider Enumeration Date:
08/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  173090 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com