Provider Demographics
NPI:1912762493
Name:WILEY, JESSICA (MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 FULTON PL
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1187
Mailing Address - Country:US
Mailing Address - Phone:301-943-7004
Mailing Address - Fax:
Practice Address - Street 1:1495 CHAIN BRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5727
Practice Address - Country:US
Practice Address - Phone:703-598-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical