Provider Demographics
NPI:1063024768
Name:LOUCKS, JESSICA KATHLEEN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHLEEN
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KATHLEEN
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2540 BILLINGSLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1990
Mailing Address - Country:US
Mailing Address - Phone:614-602-6477
Mailing Address - Fax:614-602-6493
Practice Address - Street 1:2540 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1990
Practice Address - Country:US
Practice Address - Phone:614-602-6477
Practice Address - Fax:614-602-6493
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator