Provider Demographics
NPI:1740602226
Name:BAIRD, JESSICA LESLIE (LMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LESLIE
Last Name:BAIRD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LESLIE
Other - Last Name:WUESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:4604 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-4520
Mailing Address - Country:US
Mailing Address - Phone:916-457-3129
Mailing Address - Fax:
Practice Address - Street 1:4612 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4520
Practice Address - Country:US
Practice Address - Phone:916-457-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist