Provider Demographics
NPI:1083275010
Name:BACH, JESSICA MORGAN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MORGAN
Last Name:BACH
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 1:2425 BISSO LN STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4886
Mailing Address - Country:US
Mailing Address - Phone:925-521-5726
Mailing Address - Fax:
Practice Address - Street 1:1315 FRUITVALE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2927
Practice Address - Country:US
Practice Address - Phone:510-881-5921
Practice Address - Fax:510-291-9591
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)