Provider Demographics
NPI:1053167320
Name:JESSICA TWITCHELL PSYCHOTHERAPIST
Entity type:Organization
Organization Name:JESSICA TWITCHELL PSYCHOTHERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TWITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-498-3607
Mailing Address - Street 1:625 W MADISON ST APT 2909
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2740
Mailing Address - Country:US
Mailing Address - Phone:312-498-3607
Mailing Address - Fax:
Practice Address - Street 1:625 W MADISON ST APT 2909
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2740
Practice Address - Country:US
Practice Address - Phone:312-498-3607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty