Most Relevant Information
Provider Data
| NPI Number: | 1003484668 |
| Provider Name: | JESSICA COGHLAN |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/11/2021 |
| Last Updated: | 06/11/2021 |
Provider Practice Location
11015 BLOOMFIELD AVE
SANTA FE SPRINGS
CA
906704601
Practice Location Phone/Fax
| Phone: | 5629062676 |
| Fax: |
Provider Mailing Location
11015 BLOOMFIELD AVE
SANTA FE SPRINGS
CA
906704601
Provider Mailing Phone/Fax
| Phone: | 5629062676 |
| Fax: |