Active NPI
Jessica L Bolton, PSY.D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1215186127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 27634
- Practice address
- 480 Alta Rd
San Diego, CA 92179-0001 - Phone
- (503) 715-6050
- NPI assigned
- Sep 16, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 7321599 | OR | |
| Clinical Psychologist | 103TC0700X | 27634 | CA | Primary |
Addresses
Primary practice location
480 Alta Rd
San Diego, CA 92179-0001
Mailing address
480 Alta Rd
San Diego, CA 92179-0001
Phone (503) 715-6050
Other practice location 1
1500 NE Irving St
Suite 250
Portland, OR 97232-2243
Phone (503) 233-4356
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7321599 | OR | MD | Mental Health Counselor |
| 27634 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654646400000",
"number": "1215186127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "480 ALTA RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921790001",
"telephone_number": "503-715-6050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "480 ALTA RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921790001",
"telephone_number": "503-715-6050"
}
],
"practiceLocations": [
{
"address_1": "1500 NE Irving St",
"address_2": "Suite 250",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972322243",
"country_code": "US",
"telephone_number": "503-233-4356",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BOLTON",
"first_name": "JESSICA",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-16",
"last_updated": "2022-06-08",
"certification_date": "2022-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "7321599",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "27634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.