Healthcare Provider Details

I. General information

NPI: 1922103340
Provider Name (Legal Business Name): JESSICA ANNE LIDDELL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANNE WHEELER

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 MORSE AVE
SACRAMENTO CA
95825-2135
US

IV. Provider business mailing address

8100 ACKERSON WAY
ANTELOPE CA
95843-5342
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-7329
  • Fax:
Mailing address:
  • Phone: 530-320-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY22271
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: