Provider Demographics
NPI:1568261857
Name:FOX-EDRADA, JESSIKA FRANCESAKALIA
Entity type:Individual
Prefix:
First Name:JESSIKA
Middle Name:FRANCESAKALIA
Last Name:FOX-EDRADA
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 1:3747 PACIFIC DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3928
Mailing Address - Country:US
Mailing Address - Phone:808-798-0241
Mailing Address - Fax:
Practice Address - Street 1:1050 S ACADEMY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3922
Practice Address - Country:US
Practice Address - Phone:808-798-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician