Provider Demographics
NPI:1902503964
Name:ALEA, JESSICA M (MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:ALEA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 N EGLIN PKWY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1255
Mailing Address - Country:US
Mailing Address - Phone:904-970-7222
Mailing Address - Fax:850-203-4381
Practice Address - Street 1:1271 N EGLIN PKWY UNIT 1
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1255
Practice Address - Country:US
Practice Address - Phone:904-970-7222
Practice Address - Fax:850-203-4381
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21789101YM0800X
FLMH21789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health