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General NPI Number Information
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NPI Number | 1184587099
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Entity Type | Individual
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Provider Name | JESSICA NICOLE EDWARDS
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Gender | Female
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 11801 PIERCE ST
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City | RIVERSIDE
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State | CA
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Zip | 92505-4408
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Country | US
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Telephone | 866-478-3978
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Fax |
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Provider Business Mailing Address
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Address Line | 15105 PASTURE WAY
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City | VICTORVILLE
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State | CA
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Zip | 92394-7429
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 134723
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License Number State | CA
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