Healthcare Provider Details

I. General information

NPI: 1922658061
Provider Name (Legal Business Name): JESSICA RIX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12030 DONNER PASS RD STE 1
TRUCKEE CA
96161-4989
US

IV. Provider business mailing address

12030 DONNER PASS RD STE 1
TRUCKEE CA
96161-4989
US

V. Phone/Fax

Practice location:
  • Phone: 208-207-4022
  • Fax: 208-207-4022
Mailing address:
  • Phone: 208-207-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-87482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: