Provider Demographics
NPI:1710220835
Name:FEIL, JESSIKA NICHOLE
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:NICHOLE
Last Name:FEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSIKA
Other - Middle Name:NICHOLE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5091
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93278-5091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28050 ROAD 148
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-9297
Practice Address - Country:US
Practice Address - Phone:559-747-3984
Practice Address - Fax:559-747-3984
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11212508103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst