Provider Demographics
NPI:1679915136
Name:LEECH, JESSICA L (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LEECH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3901 S ATHERTON ST STE 6
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-8324
Mailing Address - Country:US
Mailing Address - Phone:814-466-6396
Mailing Address - Fax:814-466-6056
Practice Address - Street 1:3901 S ATHERTON ST STE 6
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8324
Practice Address - Country:US
Practice Address - Phone:814-466-6396
Practice Address - Fax:814-466-6056
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003073363A00000X
PAMA056201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant