Provider Demographics
NPI:1285068023
Name:WEIS, JESSICA ANDREWS (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANDREWS
Last Name:WEIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-0677
Mailing Address - Country:US
Mailing Address - Phone:650-380-6265
Mailing Address - Fax:
Practice Address - Street 1:1420 N HIGHWAY 33 STE 103
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5313
Practice Address - Country:US
Practice Address - Phone:208-497-2260
Practice Address - Fax:208-281-4134
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2768103T00000X
WY662103T00000X
WA60721870103T00000X, 103T00000X
IDPSY-203328103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist