Provider Demographics
NPI:1083125025
Name:FOLZ, JESSICA LEIGH (NMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:FOLZ
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:FOLZ-YARUSSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NMD
Mailing Address - Street 1:6846 W WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5227
Mailing Address - Country:US
Mailing Address - Phone:513-476-7773
Mailing Address - Fax:
Practice Address - Street 1:5112 N 40TH ST STE 203
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-9183
Practice Address - Country:US
Practice Address - Phone:833-436-2537
Practice Address - Fax:623-321-7837
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1677175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath