Provider Demographics
NPI:1194153528
Name:BUSH, JESSICA RENE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENE
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128
Mailing Address - Country:US
Mailing Address - Phone:901-425-0200
Mailing Address - Fax:901-425-0199
Practice Address - Street 1:2922 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128
Practice Address - Country:US
Practice Address - Phone:901-425-0200
Practice Address - Fax:901-425-0199
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker