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General NPI Number Information
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NPI Number | 1710467170
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Entity Type | Individual
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Provider Name | JESSICA LAIRD
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Gender | Female
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 2400 MOORPARK AVE STE 319
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City | SAN JOSE
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State | CA
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Zip | 95128-2625
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Country | US
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Telephone | 408-975-2763
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 MOORPARK AVE STE 300
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City | SAN JOSE
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State | CA
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Zip | 95128-2680
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Country | US
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Telephone | 949-606-6759
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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 | 103T00000X
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Taxonomy Name | Psychologist
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | CA
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