Provider Demographics
NPI:1114599909
Name:BANKS, JESSICA S (MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:BANKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 UNION ST
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4534
Mailing Address - Country:US
Mailing Address - Phone:909-254-3996
Mailing Address - Fax:
Practice Address - Street 1:161 W MILL ST STE 103E
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1401
Practice Address - Country:US
Practice Address - Phone:909-505-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90146104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker