Provider Demographics
NPI:1326474180
Name:POWELL, JESSICA JULIA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JULIA
Last Name:POWELL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JULIA
Other - Last Name:GURCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10515 W SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3020
Mailing Address - Country:US
Mailing Address - Phone:623-832-6530
Mailing Address - Fax:
Practice Address - Street 1:10515 W SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3020
Practice Address - Country:US
Practice Address - Phone:623-832-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4302103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist