Provider Demographics
NPI:1033449897
Name:RICHARDS, JESSICA ALAIN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ALAIN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 BARTSON RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-9672
Mailing Address - Country:US
Mailing Address - Phone:419-332-5524
Mailing Address - Fax:419-332-7581
Practice Address - Street 1:1925 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4737
Practice Address - Country:US
Practice Address - Phone:419-557-5177
Practice Address - Fax:419-557-5179
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 11010671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE0001927Medicare UPIN