Provider Demographics
NPI:1598530131
Name:KISSINGER, JESSICA (PLPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KISSINGER
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LAKE FOREST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1304
Mailing Address - Country:US
Mailing Address - Phone:314-583-8947
Mailing Address - Fax:
Practice Address - Street 1:1804 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2508
Practice Address - Country:US
Practice Address - Phone:314-583-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023031665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty