Provider Demographics
NPI:1013358266
Name:BENASH, JESSICA L (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:BENASH
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:EDWARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2970
Mailing Address - Country:US
Mailing Address - Phone:608-756-5555
Mailing Address - Fax:608-756-0174
Practice Address - Street 1:903 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2970
Practice Address - Country:US
Practice Address - Phone:608-756-5555
Practice Address - Fax:608-756-0174
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7979-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1013358266Medicaid
WI1013358266OtherBCBSWI
WIBENASJESOtherMERCYCARE INSURANCE
WIBENASJESOtherMERCYCARE INSURANCE