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NPI Code Detail

MEDICARE: MS. JESSICA LEEBOWO MS

MEDICARE: MS. JESSICA LEEBOWO MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist210114365CA

General Provider Information

NPI Number : 1164806964
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA LEEBOWO MS
Provider Business Mailing Address
First Line : 225 37TH AVE, 3RD FLOOR
Second Line :
City : SAN MATEO
State : CA
Zip : 94403
Country : US
Telephone Number : 650-242-0179
Fax Number :
Provider Business Practice Location Address
First Line : 915 54TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94608-3142
Country : US
Telephone Number : 510-879-5003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2015
Last Update Date : 08/21/2024

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