Provider Demographics
NPI:1457171720
Name:LESPADE, JESSIQUE JADE
Entity type:Individual
Prefix:
First Name:JESSIQUE
Middle Name:JADE
Last Name:LESPADE
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 1:485 GOLDEN WEST PL
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3722
Mailing Address - Country:US
Mailing Address - Phone:805-668-7165
Mailing Address - Fax:
Practice Address - Street 1:330 JAMES WAY STE 180
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2891
Practice Address - Country:US
Practice Address - Phone:559-871-4749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst