Provider Demographics
NPI:1013540970
Name:DUCKWORTH, JESSICA LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 COUNTY ROAD 2020
Mailing Address - Street 2:
Mailing Address - City:KLONDIKE
Mailing Address - State:TX
Mailing Address - Zip Code:75448-6409
Mailing Address - Country:US
Mailing Address - Phone:903-461-2395
Mailing Address - Fax:
Practice Address - Street 1:259 COUNTY ROAD 2020
Practice Address - Street 2:
Practice Address - City:KLONDIKE
Practice Address - State:TX
Practice Address - Zip Code:75448-6409
Practice Address - Country:US
Practice Address - Phone:903-461-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health