Provider Demographics
NPI:1215491287
Name:WOJCIECHOWSKI, JESSIKA
Entity type:Individual
Prefix:MS
First Name:JESSIKA
Middle Name:
Last Name:WOJCIECHOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12382 BLUE STREAM DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-6671
Mailing Address - Country:US
Mailing Address - Phone:321-355-1296
Mailing Address - Fax:
Practice Address - Street 1:12382 BLUE STREAM DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-6671
Practice Address - Country:US
Practice Address - Phone:321-355-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner