Provider Demographics
NPI:1558507111
Name:HEDGE, JESSICA R (ICADC, CRADC, CDCS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:HEDGE
Suffix:
Gender:F
Credentials:ICADC, CRADC, CDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4306
Mailing Address - Country:US
Mailing Address - Phone:079-451-8164
Mailing Address - Fax:907-451-0273
Practice Address - Street 1:1027 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4306
Practice Address - Country:US
Practice Address - Phone:079-451-8164
Practice Address - Fax:907-451-0273
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)