Provider Demographics
NPI:1407693187
Name:NUSSBAUM, JOCELYN ELISE
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:ELISE
Last Name:NUSSBAUM
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 1:7114 71ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6303
Mailing Address - Country:US
Mailing Address - Phone:253-649-3240
Mailing Address - Fax:
Practice Address - Street 1:7114 71ST AVE NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6303
Practice Address - Country:US
Practice Address - Phone:253-649-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician