Healthcare Provider Details

I. General information

NPI: 1134871510
Provider Name (Legal Business Name): JESSICA BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 N PRICE RD
CHANDLER AZ
85224-1612
US

IV. Provider business mailing address

9051 N 10TH ST
PHOENIX AZ
85020-2624
US

V. Phone/Fax

Practice location:
  • Phone: 480-777-7679
  • Fax:
Mailing address:
  • Phone: 602-299-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-19524
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: