Provider Demographics
NPI:1952643090
Name:FLOERSHEIM, JESSICA LYNN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:FLOERSHEIM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FLOERSHEIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:1600 LOMA COLORADO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-7708
Mailing Address - Country:US
Mailing Address - Phone:505-891-5335
Mailing Address - Fax:505-891-1180
Practice Address - Street 1:1600 LOMA COLORADO BLVD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-7708
Practice Address - Country:US
Practice Address - Phone:505-891-5335
Practice Address - Fax:505-891-1180
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-079871041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool