MEDICARE: JESSICA SHIELDS

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	106H00000X	Marriage & Family Therapist		NV

General Provider Information

NPI Number	:	1548735269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SHIELDS

Provider Business Mailing Address
First Line	:	2851 SUNLINE DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89523-2140
Country	:	US
Telephone Number	:	775-741-8469
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 W HUFFAKER LN STE 302-303
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-2346
Country	:	US
Telephone Number	:	775-741-8469
Fax Number	:

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

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	10/09/2018

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