Provider Demographics
NPI:1316334063
Name:SIMPSON, JESSICA (MSW, ACSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 SARATOGA DR
Mailing Address - Street 2:414
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3593
Mailing Address - Country:US
Mailing Address - Phone:602-828-0226
Mailing Address - Fax:
Practice Address - Street 1:7425 LOS GUILICOS RD
Practice Address - Street 2:DEPT H
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409
Practice Address - Country:US
Practice Address - Phone:602-828-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34991104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker