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Jessica R Boulter
Student in an Organized Health Care Education/Training Program in Modesto, California
NPI 1770276859

Jessica R Boulter is a Student in an Organized Health Care Education/Training Program based in Modesto, CA. Jessica R Boulter practices in Modesto, CA. The NPI Number for Jessica R Boulter is 1770276859 and holds a License No. (California).

The current practice location address for Jessica R Boulter is 416 Corson Ave, Modesto, CA and can be reached out via phone at 209-284-0970.

Location: 416 Corson Ave, Modesto, CA, 95350-5408
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1770276859
Provider Name
Jessica R Boulter
Credential
Provider Entity Type
Individual
Gender
Female
Address
416 Corson Ave, Modesto, CA, 95350-5408
Phone Number
209-284-0970
Fax Number
Provider Enumeration Date
06/02/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
416 Corson Ave
City
Modesto
State
California
Zip
95350-5408
Phone Number
209-284-0970
Fax Number
person
Provider Business Mailing Address Details
Address
416 Corson Ave
City
Modesto
State
California
Zip
95350-5408
Phone Number
209-284-0970
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
(California)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
(California)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
(California)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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