Healthcare Provider Details

I. General information

NPI: 1124849096
Provider Name (Legal Business Name): JESSICA LEE MCGREGOR MSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAYLEE MCGREGOR

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 S AUBURN ST
GRASS VALLEY CA
95945-7576
US

IV. Provider business mailing address

10166 VIRGIL CT
GRASS VALLEY CA
95949-9154
US

V. Phone/Fax

Practice location:
  • Phone: 530-913-5054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: