Provider Demographics
NPI:1609150481
Name:RODRIGUEZ, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RODRIGUEZ
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 1:3455 W CRAIG RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5118
Mailing Address - Country:US
Mailing Address - Phone:702-982-0600
Mailing Address - Fax:702-982-0300
Practice Address - Street 1:3455 W CRAIG RD
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5118
Practice Address - Country:US
Practice Address - Phone:702-982-0600
Practice Address - Fax:702-982-0300
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1702979061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health