MEDICARE: DR. JESSICA R BLAND PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810005408	VA
2	103TC0700X	Clinical Psychologist	13038	FL
3	103TC0700X	Clinical Psychologist	1413	SC
4	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1073915526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA R BLAND PSY.D.

Provider Business Mailing Address
First Line	:	670 BOULEVARD DE FRANCE
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 BOULEVARD DE FRANCE
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902
Country	:	US
Telephone Number	:	843-228-3869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	06/18/2026

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