Individual
MRS. JESSICA AUDRYLEE WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
7219 N LITCHFIELD RD BLDG 317, 56MOS/SGOHF - LUKE AIR FORCE BASE, GLENDALE, AZ 85309-1529
(877) 557-3422
(877) 875-2500
Mailing address
5901 W BEHREND DR APT 2134, GLENDALE, AZ 85308-6954
(623) 877-0599
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW10272
AZ
Other
Enumeration date
10/23/2006
Last updated
07/08/2007
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