Healthcare Provider Details

I. General information

NPI: 1760820427
Provider Name (Legal Business Name): JESSICA LORRAINE SAUCEDO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LORRAINE SANCHEZ LCSW

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 N GLASSFORD HILL RD STE 108
PRESCOTT VALLEY AZ
86314-2256
US

IV. Provider business mailing address

2414 W OLD PAINT TRL
PHOENIX AZ
85086-6608
US

V. Phone/Fax

Practice location:
  • Phone: 844-385-3747
  • Fax: 480-462-2801
Mailing address:
  • Phone: 844-385-3747
  • Fax: 480-462-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW64926
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number86703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: