Healthcare Provider Details

I. General information

NPI: 1891082244
Provider Name (Legal Business Name): MS. JESSICA GRACE MAUST DAHLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA GRACE MAUST

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E COLORADO BLVD
PASADENA CA
91101-6143
US

IV. Provider business mailing address

3205 E DEL MAR BLVD
PASADENA CA
91107-4651
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax:
Mailing address:
  • Phone: 626-534-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number66824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: