Provider Demographics
NPI:1386324697
Name:HEALY, JESSICA (ABO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HEALY
Suffix:
Gender:F
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 18TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1853
Mailing Address - Country:US
Mailing Address - Phone:507-460-4161
Mailing Address - Fax:507-433-0065
Practice Address - Street 1:1000 18TH AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1853
Practice Address - Country:US
Practice Address - Phone:507-460-4161
Practice Address - Fax:507-433-0065
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN206712156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician