MEDICARE: DR. JESSICA DESALU

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	0810006387	VA

General Provider Information

NPI Number	:	1992337273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA DESALU

Provider Business Mailing Address
First Line	:	2227 BEL PRE RD # 141
Second Line	:
City	:	ASPEN HILL
State	:	MD
Zip	:	20906-2204
Country	:	US
Telephone Number	:	202-922-7108
Fax Number	:

Provider Business Practice Location Address
First Line	:	2227 BEL PRE RD # 141
Second Line	:
City	:	ASPEN HILL
State	:	MD
Zip	:	20906-2204
Country	:	US
Telephone Number	:	202-922-7108
Fax Number	:

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

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	05/24/2022

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