Provider Demographics
NPI:1164902284
Name:BELLE, JESSE KATHERINE (MSED, LCPC)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:KATHERINE
Last Name:BELLE
Suffix:
Gender:F
Credentials:MSED, LCPC
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:WOOLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, LCPC
Mailing Address - Street 1:1639 N ALPINE RD STE 403
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1440
Mailing Address - Country:US
Mailing Address - Phone:815-694-0626
Mailing Address - Fax:
Practice Address - Street 1:1639 N ALPINE RD STE 403
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1440
Practice Address - Country:US
Practice Address - Phone:815-229-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional