Provider Demographics
NPI:1801243258
Name:MORGAN, JESSICA RANDALL (PSYD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RANDALL
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4008 E WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-1415
Mailing Address - Country:US
Mailing Address - Phone:480-241-9025
Mailing Address - Fax:480-241-9025
Practice Address - Street 1:1432 S DOBSON RD STE 408
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4777
Practice Address - Country:US
Practice Address - Phone:480-412-7486
Practice Address - Fax:480-412-7476
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-5057103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist