Provider Demographics
NPI:1386442085
Name:SNODGRASS, JESSICA ARLENE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ARLENE
Last Name:SNODGRASS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 S RECOVERY RD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-8901
Mailing Address - Country:US
Mailing Address - Phone:209-888-6595
Mailing Address - Fax:209-888-6596
Practice Address - Street 1:7236 S RECOVERY RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-8901
Practice Address - Country:US
Practice Address - Phone:209-888-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172V00000XOther Service ProvidersCommunity Health Worker