Provider Demographics
NPI:1033545850
Name:EPPERSON, JESSICA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:EPPERSON
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 1:1215 VANDALIA ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4060
Mailing Address - Country:US
Mailing Address - Phone:618-343-6015
Mailing Address - Fax:618-578-5759
Practice Address - Street 1:1215 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4060
Practice Address - Country:US
Practice Address - Phone:618-343-6015
Practice Address - Fax:618-578-5759
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490160301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical