Provider Demographics
NPI:1851751622
Name:YNIGUEZ, JESSICA ANNIE (CADC-CAS)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ANNIE
Last Name:YNIGUEZ
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12426 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1017
Mailing Address - Country:US
Mailing Address - Phone:562-944-7953
Mailing Address - Fax:562-946-7494
Practice Address - Street 1:16314 CORNUTA AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4814
Practice Address - Country:US
Practice Address - Phone:562-461-9272
Practice Address - Fax:562-920-1960
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC23261214324500000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC23261214OtherCCAPP CREDENTIALING