Provider Demographics
NPI:1639589310
Name:SCHRECKENGOST, JESS
Entity Type:Individual
Prefix:
First Name:JESS
Middle Name:
Last Name:SCHRECKENGOST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 W BLAINE ST STE C
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3940
Mailing Address - Country:US
Mailing Address - Phone:951-358-4120
Mailing Address - Fax:951-358-4189
Practice Address - Street 1:771 W BLAINE ST STE C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-3940
Practice Address - Country:US
Practice Address - Phone:951-358-4120
Practice Address - Fax:951-358-4189
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional