Provider Demographics
NPI:1629613336
Name:PLAZA, JESSICA ELENA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELENA
Last Name:PLAZA
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 1:3646 COMO CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-6622
Mailing Address - Country:US
Mailing Address - Phone:602-614-6063
Mailing Address - Fax:
Practice Address - Street 1:710 11TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-6405
Practice Address - Country:US
Practice Address - Phone:970-888-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty