Basic Information
| Provider Information | |||||||||
| NPI: | 1669866091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLISON | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | SUSAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CM, LM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 LANSING STREET | ||||||||
| Address2: | ATTN: C. MCLOUD | ||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155670455 | ||||||||
| FaxNumber: | 3152531795 | ||||||||
| Practice Location | |||||||||
| Address1: | 143 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152525028 | ||||||||
| FaxNumber: | 3152521587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2015 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 001676 | NY | Y | Other Service Providers | Midwife |
No ID Information.