Provider Demographics
NPI:1053595587
Name:WRIGHT, JESSICA L (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 BOW DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1403
Mailing Address - Country:US
Mailing Address - Phone:253-376-9761
Mailing Address - Fax:
Practice Address - Street 1:623 BOW DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1403
Practice Address - Country:US
Practice Address - Phone:253-376-9761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0189101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical