Provider Demographics
NPI:1699315119
Name:JESSUP, CARRIE FRANCES (MS ED)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:FRANCES
Last Name:JESSUP
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:FRANCES
Other - Last Name:ARSENAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 EVANS ST APT E
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5630
Mailing Address - Country:US
Mailing Address - Phone:716-566-0810
Mailing Address - Fax:
Practice Address - Street 1:4242 RIDGE LEA RD STE 2
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-5122
Practice Address - Country:US
Practice Address - Phone:716-819-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist