Provider Demographics
NPI:1215925516
Name:DOUGLAS, JESSICA L (MS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4813
Mailing Address - Country:US
Mailing Address - Phone:508-653-7866
Mailing Address - Fax:508-334-3525
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:S1-710
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-3517
Practice Address - Fax:508-334-3525
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS