Jessica Lee Gostlin, MA LLP
Individual provider Active NPI Psychologist · Hancock, MI
NPI 1477565760 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1477565760
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 6301010858 (MI)
- Practice address
- 1205 Sigsbee St
Hancock, MI 49930-1352 - Phone
- (906) 370-8357
- NPI assigned
- Aug 13, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301010858 | MI | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301010858 | MI | Yes |
Addresses
Primary practice location
1205 Sigsbee St
Hancock, MI 49930-1352
Mailing address
1205 Sigsbee St
Hancock, MI 49930-1352
Phone (906) 370-8357
Other providers in Hancock, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.