Provider Demographics
NPI:1447779616
Name:CONNER, JESSICA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N STEPHANIE ST STE 811
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-8725
Mailing Address - Country:US
Mailing Address - Phone:702-294-0433
Mailing Address - Fax:
Practice Address - Street 1:375 N STEPHANIE ST STE 811
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8725
Practice Address - Country:US
Practice Address - Phone:702-294-0433
Practice Address - Fax:702-446-8363
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVPI034103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program