Provider Demographics
NPI:1992800841
Name:MCDONNELL, JESSICA JEAN (BA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JEAN
Other - Last Name:LEADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 520555
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:AK
Mailing Address - Zip Code:99652-0555
Mailing Address - Country:US
Mailing Address - Phone:907-892-2332
Mailing Address - Fax:907-892-2332
Practice Address - Street 1:2735 E TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1135
Practice Address - Country:US
Practice Address - Phone:907-762-8694
Practice Address - Fax:907-562-7901
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health