Provider Demographics
NPI:1215590963
Name:ELSTON, JESSICA ROSETTE (BS, BA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSETTE
Last Name:ELSTON
Suffix:
Gender:F
Credentials:BS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:BARROW
Mailing Address - State:AK
Mailing Address - Zip Code:99723-0893
Mailing Address - Country:US
Mailing Address - Phone:907-782-9889
Mailing Address - Fax:
Practice Address - Street 1:5200 LAURA MADISON
Practice Address - Street 2:
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723
Practice Address - Country:US
Practice Address - Phone:907-852-0366
Practice Address - Fax:907-852-6210
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor