Provider Demographics
NPI:1558734772
Name:PECHAN, JESSICA (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PECHAN
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W WALNUT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1747
Mailing Address - Country:US
Mailing Address - Phone:513-885-3039
Mailing Address - Fax:
Practice Address - Street 1:33 W WALNUT ST STE 2
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1747
Practice Address - Country:US
Practice Address - Phone:513-885-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI19016451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0279509Medicaid