Healthcare Provider Details

I. General information

NPI: 1811518905
Provider Name (Legal Business Name): JESICA SUZANNE WESTWRIGHT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 09/10/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9501
US

IV. Provider business mailing address

1371 NEEL ST
HUNTINGTON WV
25701-4005
US

V. Phone/Fax

Practice location:
  • Phone: 43-429-6741
  • Fax:
Mailing address:
  • Phone: 410-330-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3808
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: