Provider Demographics
NPI:1104176403
Name:SWOPE, JESSICA SANDHAM (PHD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SANDHAM
Last Name:SWOPE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:SANDHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 19TH STREET, NW
Mailing Address - Street 2:#200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036
Mailing Address - Country:US
Mailing Address - Phone:917-855-3811
Mailing Address - Fax:
Practice Address - Street 1:1320 19TH STREET, NW
Practice Address - Street 2:#200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036
Practice Address - Country:US
Practice Address - Phone:917-855-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical