Provider Demographics
NPI:1033763792
Name:BELK, JESSICA LEE (CDC II, PSP II)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:BELK
Suffix:
Gender:F
Credentials:CDC II, PSP II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871545
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-1545
Mailing Address - Country:US
Mailing Address - Phone:907-376-4534
Mailing Address - Fax:
Practice Address - Street 1:26731 W POINT MACKENZIE RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-8709
Practice Address - Country:US
Practice Address - Phone:907-376-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist