1609541952 NPI number — JESSICA SAREUSSEN

Table of content: JESSICA SAREUSSEN (NPI 1609541952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609541952 NPI number — JESSICA SAREUSSEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAREUSSEN
Provider First Name:
JESSICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JESSICA
Provider Other First Name:
JESSICA
Provider Other Middle Name:
JESSICA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609541952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39059-0168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-588-9641
Provider Business Mailing Address Fax Number:
888-711-0441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 SUNSET BLVD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70065-6810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-588-9641
Provider Business Practice Location Address Fax Number:
888-711-0441
Provider Enumeration Date:
08/10/2021

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: 225X00000X , with the licence number:  327805 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 327805 . This is a "OCCUPATIONAL THERAPY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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