Provider Demographics
NPI:1508102427
Name:OLDFIELD, JESSICA N (MED, LPCA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:OLDFIELD
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 HIGHWAY 15 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-7247
Mailing Address - Country:US
Mailing Address - Phone:606-666-5696
Mailing Address - Fax:606-666-5696
Practice Address - Street 1:1550 HIGHWAY 15 S
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-7247
Practice Address - Country:US
Practice Address - Phone:606-666-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KYLPCCCA00218288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator