Provider Demographics
NPI:1407633985
Name:PACKARD, JESSICA (MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PACKARD
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 1:94177 GOODWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-0187
Mailing Address - Country:US
Mailing Address - Phone:509-845-1029
Mailing Address - Fax:
Practice Address - Street 1:94177 GOODWOOD DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-0187
Practice Address - Country:US
Practice Address - Phone:509-845-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical