Provider Demographics
NPI:1871160028
Name:MCNAIR, JESSICA ASHLEY-MARIE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ASHLEY-MARIE
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 DA VINCI WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2325
Mailing Address - Country:US
Mailing Address - Phone:510-754-8369
Mailing Address - Fax:510-754-8369
Practice Address - Street 1:601 UNIVERSITY AVE STE 175
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6739
Practice Address - Country:US
Practice Address - Phone:818-241-6780
Practice Address - Fax:818-241-6780
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician