Provider Demographics
NPI:1972315406
Name:PHILLIPS, JESSICA T
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:T
Last Name:PHILLIPS
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 1:1736 PENNWAY PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3301
Mailing Address - Country:US
Mailing Address - Phone:937-260-6840
Mailing Address - Fax:
Practice Address - Street 1:1736 PENNWAY PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3301
Practice Address - Country:US
Practice Address - Phone:937-260-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker