Provider Demographics
NPI:1609478965
Name:SMITH, JESSICA LYNN (MSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 DAVIS CIR TRLR 12
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:TX
Mailing Address - Zip Code:75755-2464
Mailing Address - Country:US
Mailing Address - Phone:903-497-2517
Mailing Address - Fax:
Practice Address - Street 1:600 DAVIS CIR TRLR 12
Practice Address - Street 2:
Practice Address - City:BIG SANDY
Practice Address - State:TX
Practice Address - Zip Code:75755-2464
Practice Address - Country:US
Practice Address - Phone:903-497-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker