Individual
JESSICA LYNN GUTIERREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 W TOKAY ST, LODI, CA 95240-3965
(209) 336-8206
Mailing address
1111 W TOKAY ST, LODI, CA 95240-3965
(209) 695-8255
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F7292285
DRIVER LICENSE
CA
Enumeration date
05/03/2022
Last updated
05/07/2025
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