Provider Demographics
NPI:1558743161
Name:WATROUS, JESSICA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:R
Last Name:WATROUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 BALBOA AVE STE 803
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6920
Mailing Address - Country:US
Mailing Address - Phone:858-214-7877
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE STE 803
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6920
Practice Address - Country:US
Practice Address - Phone:858-214-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical