Provider Demographics
NPI:1558029835
Name:BRASS, JESSICA JANE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:BRASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:JANE
Other - Last Name:BRASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2004 ZINFANDEL DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4202
Mailing Address - Country:US
Mailing Address - Phone:916-604-2108
Mailing Address - Fax:
Practice Address - Street 1:8950 CAL CENTER DR STE 137
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3236
Practice Address - Country:US
Practice Address - Phone:866-523-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician