Provider Demographics
NPI:1871471136
Name:GONZALEZ, JESSICA ISABEL
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ISABEL
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 VICTOR ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3129
Mailing Address - Country:US
Mailing Address - Phone:567-395-5739
Mailing Address - Fax:567-395-5739
Practice Address - Street 1:95 VICTOR ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-3129
Practice Address - Country:US
Practice Address - Phone:313-252-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker