Jessica Alexandra Knowles, SUDRC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

13795 Issued in CA

Practice address

1143 Missouri St
Fairfield, CA 94533-6007

Phone

(707) 435-9911

Fax

(707) 435-0704

NPI assigned

Aug 10, 2022

Last updated

Aug 10, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1881322584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1143 MISSOURI ST",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336007",
            "telephone_number": "707-435-9911",
            "fax_number": "707-435-0704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1143 MISSOURI ST",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336007",
            "telephone_number": "707-435-9911",
            "fax_number": "707-435-0704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNOWLES",
        "first_name": "JESSICA",
        "middle_name": "ALEXANDRA",
        "credential": "SUDRC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-10",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "13795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.baymark.com",
            "affiliation": "N",
            "endpointDescription": "www.baymark.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1143 Missouri St",
            "city": "Fairfield",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945336007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Max Kline
• Jenna Lee Klopping
• Christian Heinrich Kniep
• La Tasha Marie Knighten
• Christine M Knob, PHYSICIAN ASSISTANT
• Bonita Knuckles
• Sierra Knuckles
• Jessica Knutson
• Mark Gerald Koch, MFT
• Malaysia Kocher

• Addiction (Substance Use Disorder) Counselor in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.

Verify at the official NPI Registry.