Provider Demographics
NPI:1770757544
Name:WOOD, JESSICA RAE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:WOOD
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 1:560 COHASSET RD STE 175
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2212
Mailing Address - Country:US
Mailing Address - Phone:530-891-2784
Mailing Address - Fax:
Practice Address - Street 1:560 COHASSET RD STE 175
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2212
Practice Address - Country:US
Practice Address - Phone:530-891-2784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 52662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist