Provider Demographics
NPI:1962226936
Name:AVERY, JESSICA (IHP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:IHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21453 S 229TH WAY
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-2823
Mailing Address - Country:US
Mailing Address - Phone:509-429-7395
Mailing Address - Fax:
Practice Address - Street 1:21453 S 229TH WAY
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-2823
Practice Address - Country:US
Practice Address - Phone:509-429-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty