| NPI | 1114516655 |
|---|---|
| Former Name | JESSICA KNICKERBOCKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2505870) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2305105) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2025-10-30 |