Provider Demographics
NPI:1104214766
Name:HARDESTY, JALISSA (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:JALISSA
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 16TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3302
Mailing Address - Country:US
Mailing Address - Phone:202-939-7700
Mailing Address - Fax:
Practice Address - Street 1:3101 16TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3302
Practice Address - Country:US
Practice Address - Phone:202-939-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool