Healthcare Provider Details

I. General information

NPI: 1316545635
Provider Name (Legal Business Name): JESSICA ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 W ABRIENDO AVE
PUEBLO CO
81004-1128
US

IV. Provider business mailing address

41 MONTEBELLO RD STE 204
PUEBLO CO
81001-1379
US

V. Phone/Fax

Practice location:
  • Phone: 719-545-2746
  • Fax:
Mailing address:
  • Phone: 719-545-2746
  • Fax: 719-545-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09930467
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: