Provider Demographics
NPI:1184271447
Name:LAIRD, JESS NICHOLAS (ASW)
Entity type:Individual
Prefix:
First Name:JESS
Middle Name:NICHOLAS
Last Name:LAIRD
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2118 WILLOW PASS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2414
Mailing Address - Country:US
Mailing Address - Phone:925-692-0090
Mailing Address - Fax:
Practice Address - Street 1:2118 WILLOW PASS RD STE 500
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2414
Practice Address - Country:US
Practice Address - Phone:925-692-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA909811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical