Healthcare Provider Details

I. General information

NPI: 1265694947
Provider Name (Legal Business Name): JESSICA KATHRYN DEAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N BACKUS AVE
PASADENA CA
91107
US

IV. Provider business mailing address

6321 S. 79TH CIRCLE
RALSTON NE
68127
US

V. Phone/Fax

Practice location:
  • Phone: 402-212-9181
  • Fax:
Mailing address:
  • Phone: 402-212-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1733
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: