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General NPI Number Information
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NPI Number | 1114599909
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Entity Type | Individual
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Provider Name | JESSICA S BANKS MSW
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Gender | Female
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 161 W MILL ST STE 103E
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-1401
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Country | US
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Telephone | 909-505-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 2851 UNION ST
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City | RIALTO
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State | CA
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Zip | 92376-4534
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Country | US
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Telephone | 909-254-3996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 90146
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License Number State | CA
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