Provider Demographics
NPI:1962931154
Name:HENNAGER, JESSICA MICHAELA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHAELA
Last Name:HENNAGER
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 1:2200 EASTSIDE HWY
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-9616
Mailing Address - Country:US
Mailing Address - Phone:406-360-8221
Mailing Address - Fax:
Practice Address - Street 1:2200 EASTSIDE HWY
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:MT
Practice Address - Zip Code:59828-9616
Practice Address - Country:US
Practice Address - Phone:406-360-8221
Practice Address - Fax:406-360-8221
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child