=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568929693
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA CHRISTINE BOURNES-JASON LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2019
-----------------------------------------------------
Last Update Date | 01/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10040 I 10 SERVICE RD STE B
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70127-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-821-8220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6041 MOUNES ST APT Q253
-----------------------------------------------------
City | RIVER RIDGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70123-6000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-234-4818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 15626
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------