Healthcare Provider Details

I. General information

NPI: 1134700933
Provider Name (Legal Business Name): JESSICA WRIGHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 E THOMAS RD STE 100
PHOENIX AZ
85016-8220
US

IV. Provider business mailing address

1210 E BETHANY HOME RD APT 210
PHOENIX AZ
85014-2089
US

V. Phone/Fax

Practice location:
  • Phone: 602-957-2507
  • Fax:
Mailing address:
  • Phone: 717-379-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-18723
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL12349
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: