Provider Demographics
NPI:1639338833
Name:NELSON, JESSICA ANN
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:NELSON
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 1:120 CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-3240
Mailing Address - Country:US
Mailing Address - Phone:310-704-8679
Mailing Address - Fax:
Practice Address - Street 1:120 CLARKSON ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-3240
Practice Address - Country:US
Practice Address - Phone:714-871-5646
Practice Address - Fax:714-817-7368
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist