Healthcare Provider Details

I. General information

NPI: 1619484128
Provider Name (Legal Business Name): JESSICA JEFFERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA POWELL

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WASHINGTON BLVD STE 230
PASADENA CA
91107-1449
US

IV. Provider business mailing address

2750 E WASHINGTON BLVD STE 230
PASADENA CA
91107-1449
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: