MEDICARE: MRS. JESSICA GAIL AIELLO SUDCC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LR03110523	CA

General Provider Information

NPI Number	:	1538807391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA GAIL AIELLO SUDCC

Provider Business Mailing Address
First Line	:	3111 S WEST ST
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93277-7542
Country	:	US
Telephone Number	:	559-737-0469
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 BIRMINGHAM DR STE 240A
Second Line	:
City	:	CARDIFF
State	:	CA
Zip	:	92007-1757
Country	:	US
Telephone Number	:	858-208-0121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	01/14/2026

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