Provider Demographics
NPI:1154673754
Name:PRISK, JESSICA MAY
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAY
Last Name:PRISK
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 1:341 BROADWAY ST STE 412
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5343
Mailing Address - Country:US
Mailing Address - Phone:530-282-5151
Mailing Address - Fax:
Practice Address - Street 1:341 BROADWAY ST STE 412
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5343
Practice Address - Country:US
Practice Address - Phone:530-282-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA931291041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical