Provider Demographics
NPI:1225288897
Name:EDWARDS, JESSICA S (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA
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 993612
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-3612
Mailing Address - Country:US
Mailing Address - Phone:530-262-8943
Mailing Address - Fax:530-275-2854
Practice Address - Street 1:1724 WEST ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1725
Practice Address - Country:US
Practice Address - Phone:530-247-3342
Practice Address - Fax:530-247-3383
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47973106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist