Provider Demographics
NPI:1417665944
Name:CORDRAY, JESSICA MICHELE
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELE
Last Name:CORDRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 LITCHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2290
Mailing Address - Country:US
Mailing Address - Phone:904-814-9680
Mailing Address - Fax:
Practice Address - Street 1:3550 N GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8823
Practice Address - Country:US
Practice Address - Phone:407-516-7918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional