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General NPI Number Information
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NPI Number | 1124758701
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Entity Type | Individual
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Provider Name | JESSYCA FRIESELL
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Gender | Female
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 1144 S 2ND ST
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City | SAN JOSE
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State | CA
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Zip | 95112-5974
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Country | US
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Telephone | 510-290-3513
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Fax |
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Provider Business Mailing Address
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Address Line | 617 LOS OLIVOS DR
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City | SANTA CLARA
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State | CA
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Zip | 95050-5524
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Country | US
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Telephone | 831-252-1679
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | A065481224
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License Number State | CA
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