Provider Demographics
NPI:1063558955
Name:FRENCKEN, JESSICA DAWN (MPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:FRENCKEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 NW 1150TH RD
Mailing Address - Street 2:
Mailing Address - City:CHILHOWEE
Mailing Address - State:MO
Mailing Address - Zip Code:64733-8107
Mailing Address - Country:US
Mailing Address - Phone:660-525-6267
Mailing Address - Fax:660-885-2404
Practice Address - Street 1:148 NW 1150TH RD
Practice Address - Street 2:
Practice Address - City:CHILHOWEE
Practice Address - State:MO
Practice Address - Zip Code:64733-8107
Practice Address - Country:US
Practice Address - Phone:660-525-6267
Practice Address - Fax:660-885-2404
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005022728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist