Provider Demographics
NPI:1497421028
Name:RADFORD, JANESSA LEE
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:LEE
Last Name:RADFORD
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 1:3856 SAMUELSON WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2048
Mailing Address - Country:US
Mailing Address - Phone:925-683-8911
Mailing Address - Fax:
Practice Address - Street 1:4125 TEMESCAL ST
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7558
Practice Address - Country:US
Practice Address - Phone:916-877-6894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker