Provider Demographics
NPI:1295818607
Name:WHITAKER, JESSICA AUDRYLEE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:AUDRYLEE
Last Name:WHITAKER
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 1:5901 W BEHREND DR APT 2134
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6954
Mailing Address - Country:US
Mailing Address - Phone:623-877-0599
Mailing Address - Fax:
Practice Address - Street 1:7219 N LITCHFIELD RD BLDG 317
Practice Address - Street 2:56MOS/SGOHF - LUKE AIR FORCE BASE
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85309-1529
Practice Address - Country:US
Practice Address - Phone:877-557-3422
Practice Address - Fax:877-875-2500
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW10272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health