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General NPI Number Information
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NPI Number | 1801603998
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Entity Type | Individual
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Provider Name | JESSICA LAKS
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Gender | Female
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 850 HUNGERFORD DR RM 50
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City | ROCKVILLE
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State | MD
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Zip | 20850-1718
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Country | US
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Telephone | 240-740-5640
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Fax |
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Provider Business Mailing Address
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Address Line | 19303 BAKERS RUN CT
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City | BROOKEVILLE
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State | MD
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Zip | 20833-3202
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Country | US
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Telephone | 203-858-5204
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | CER-120838-K4V9J0
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License Number State | MD
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