Individual
JESSICA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
70 W MANOR ST, ALTADENA, CA 91001-4714
(626) 394-3308
Mailing address
70 W MANOR ST, ALTADENA, CA 91001-4714
(626) 394-3308
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
172V00000X
Community Health Worker
—
—
372600000X
Adult Companion
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101Y00000X
OTHER
CA
01
—
372600000X
OTHER
CA
Enumeration date
08/17/2023
Last updated
06/03/2025
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