Provider Demographics
NPI:1124401203
Name:ROWE, JESSICA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:ROWE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 OAK AVENUE PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6866
Mailing Address - Country:US
Mailing Address - Phone:916-500-4054
Mailing Address - Fax:916-260-5837
Practice Address - Street 1:750 OAK AVENUE PKWY
Practice Address - Street 2:STE 160
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-500-4054
Practice Address - Fax:916-260-5837
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30803103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124401203OtherWHEN I WORKED WITH MISSION MENTAL HEALTH