Provider Demographics
NPI:1689481244
Name:KUETERMAN, JESSICA L
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:KUETERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:LADOGA
Mailing Address - State:IN
Mailing Address - Zip Code:47954-9350
Mailing Address - Country:US
Mailing Address - Phone:317-363-8723
Mailing Address - Fax:
Practice Address - Street 1:752 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:LADOGA
Practice Address - State:IN
Practice Address - Zip Code:47954-9350
Practice Address - Country:US
Practice Address - Phone:317-363-8723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171400000XOther Service ProvidersHealth & Wellness Coach