Healthcare Provider Details

I. General information

NPI: 1558788547
Provider Name (Legal Business Name): JESSICA MARIE MICHELI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MARIE SANCHEZ

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 W CLARA AVE
FOWLER CA
93625-4456
US

IV. Provider business mailing address

1345 W CLARA AVE
FOWLER CA
93625-4456
US

V. Phone/Fax

Practice location:
  • Phone: 559-316-7118
  • Fax:
Mailing address:
  • Phone: 559-316-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: