Provider Demographics
NPI:1619852704
Name:ELLERTSON, JESSICA RENE (PSYD, PPS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RENE
Last Name:ELLERTSON
Suffix:
Gender:F
Credentials:PSYD, PPS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CONTRERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8510 LAKE KNOLL AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1275
Mailing Address - Country:US
Mailing Address - Phone:714-552-8079
Mailing Address - Fax:
Practice Address - Street 1:8510 LAKE KNOLL AVE UNIT C
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1275
Practice Address - Country:US
Practice Address - Phone:714-552-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool