Provider Demographics
NPI:1427373414
Name:LARSON, JESSICA A (MED, LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:LARSON
Suffix:
Gender:F
Credentials:MED, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10S531 RUTGERS CT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-5131
Mailing Address - Country:US
Mailing Address - Phone:331-201-0676
Mailing Address - Fax:
Practice Address - Street 1:3825 HIGHLAND AVENUE
Practice Address - Street 2:TOWER 1 SUITE 3K
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-277-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5430101YP2500X
COLPC.0005430101YP2500X
IL166.001132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional