Provider Demographics
NPI:1417644394
Name:BASS, JEAN
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6 BLUEBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4940
Mailing Address - Country:US
Mailing Address - Phone:978-335-1793
Mailing Address - Fax:
Practice Address - Street 1:6 BLUEBERRY WAY
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4940
Practice Address - Country:US
Practice Address - Phone:978-335-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist