Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003106352 |
---|---|
Provider Name | Jessica Jo Taylor Gallo |
First Address | Ebensburg, PA 15931-1539 |
Second Address | Ebensburg, PA 15931-1539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 07/04/2011 |