Healthcare Provider Details

I. General information

NPI: 1003345992
Provider Name (Legal Business Name): JESSICA ELIZABETH WILINSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE BLDG 4
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

1055 ALTURA DR
RIVERSIDE CA
92507-2818
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8000
  • Fax:
Mailing address:
  • Phone: 818-536-9079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: