Provider Demographics
NPI:1336868652
Name:ANDREYCHUK, JESSICA TAYLOR
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:TAYLOR
Last Name:ANDREYCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:TAYLOR
Other - Last Name:ANDREYCHUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5040 E SHEA BLVD STE 164
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5040 E SHEA BLVD STE 164
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4686
Practice Address - Country:US
Practice Address - Phone:480-641-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy