Provider Demographics
NPI:1356835532
Name:ALLISON, JESSICA LYNN (LSESW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:ALLISON
Suffix:
Gender:F
Credentials:LSESW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICES LLC
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-371-1414
Mailing Address - Fax:785-371-4519
Practice Address - Street 1:3320 PETERSON RD FAMILY PSYCHOLOGICAL SERVICES LLC
Practice Address - Street 2:SUITE 104
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-371-1414
Practice Address - Fax:785-371-4519
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS054141041C0700X
KS10948104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201203780AMedicaid