1023509247 NPI number — JESSICA FRALEY HARDING MSW

Table of content: JESSICA FRALEY HARDING MSW (NPI 1023509247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023509247 NPI number — JESSICA FRALEY HARDING MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDING
Provider First Name:
JESSICA
Provider Middle Name:
FRALEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRALEY
Provider Other First Name:
JESSICA
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023509247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10150 E KAREN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85748-3454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-396-9298
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 S 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85723-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-792-1450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)