Provider Demographics
NPI:1972851996
Name:DITSON, JESSICA LYNN
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:DITSON
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 1:612 PUSAN DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-8148
Mailing Address - Country:US
Mailing Address - Phone:817-471-9859
Mailing Address - Fax:
Practice Address - Street 1:3142 VISTA WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3619
Practice Address - Country:US
Practice Address - Phone:760-726-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker