Provider Demographics
NPI:1346494366
Name:WILKERSON, JESSICA BRADLEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BRADLEY
Last Name:WILKERSON
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 1:104 COCKRELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1465
Mailing Address - Country:US
Mailing Address - Phone:865-304-1045
Mailing Address - Fax:
Practice Address - Street 1:305 S BROADWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7344
Practice Address - Country:US
Practice Address - Phone:903-939-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN57121041C0700X
TX1075361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical