Provider Demographics
NPI:1093259772
Name:PAVELKA, JESSICA (MS, LPC, NCC, RYT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PAVELKA
Suffix:
Gender:F
Credentials:MS, LPC, NCC, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WALNUT ST
Mailing Address - Street 2:1005
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2944
Mailing Address - Country:US
Mailing Address - Phone:267-551-1270
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE 1005
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:267-551-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional