Healthcare Provider Details

I. General information

NPI: 1053433433
Provider Name (Legal Business Name): JESSICA LEIGH JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LEIGH DURKEE LCSW

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22245 MAIN ST SUITE 200
HAYWARD CA
94541-4028
US

IV. Provider business mailing address

22245 MAIN ST STE 200
HAYWARD CA
94541-4028
US

V. Phone/Fax

Practice location:
  • Phone: 510-727-9401
  • Fax: 510-727-9405
Mailing address:
  • Phone: 510-727-9401
  • Fax: 510-727-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number71325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: