Healthcare Provider Details

I. General information

NPI: 1710817739
Provider Name (Legal Business Name): JESSIKAH INGLEY CMPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 KANSAS AVE STE B
MODESTO CA
95351-1596
US

IV. Provider business mailing address

901 CALIFORNIA AVE APT 12
MODESTO CA
95351-2584
US

V. Phone/Fax

Practice location:
  • Phone: 209-579-1151
  • Fax: 209-579-9605
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-DYIQSE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: