Provider Demographics
NPI:1871929034
Name:DYER, JESSICA (ASW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DYER
Suffix:
Gender:
Credentials:ASW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAPLE
Mailing Address - Street 1:381 BAYSIDE RD STE C
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-7102
Mailing Address - Country:US
Mailing Address - Phone:707-601-9734
Mailing Address - Fax:
Practice Address - Street 1:381 BAYSIDE RD STE C
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-7102
Practice Address - Country:US
Practice Address - Phone:707-601-9734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69106101YM0800X, 1041C0700X
CA32053104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker