| NPI | 1336577253 |
|---|---|
| Former Name | JESSICA LEIGH JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 1106-039) |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2013-10-31 |