Provider Demographics
NPI:1346740172
Name:BARTZ, JESSICA A (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BARTZ
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 40TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7215
Mailing Address - Country:US
Mailing Address - Phone:309-558-9050
Mailing Address - Fax:888-243-3903
Practice Address - Street 1:2424 40TH AVE APT 5
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7215
Practice Address - Country:US
Practice Address - Phone:309-558-9050
Practice Address - Fax:888-243-3903
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional