Provider Demographics
NPI:1982270450
Name:ADAMS, JESSICA (BA PSY)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:BA PSY
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA PSY
Mailing Address - Street 1:16791 HOWARD LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36580-4042
Mailing Address - Country:US
Mailing Address - Phone:251-367-7052
Mailing Address - Fax:
Practice Address - Street 1:16791 HOWARD LN
Practice Address - Street 2:
Practice Address - City:SUMMERDALE
Practice Address - State:AL
Practice Address - Zip Code:36580-4042
Practice Address - Country:US
Practice Address - Phone:251-367-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist