Provider Demographics
NPI:1083901144
Name:TALBERT, JESSICA GORDON (MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GORDON
Last Name:TALBERT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2053
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-2053
Mailing Address - Country:US
Mailing Address - Phone:704-484-2558
Mailing Address - Fax:704-484-2042
Practice Address - Street 1:425C CHERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3651
Practice Address - Country:US
Practice Address - Phone:704-484-2558
Practice Address - Fax:704-484-2042
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0054171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical