Provider Demographics
NPI:1619490588
Name:CLEMONS, JESSICA LANE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LANE
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 ROCKY HILL ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSON
Mailing Address - State:KY
Mailing Address - Zip Code:42726-8441
Mailing Address - Country:US
Mailing Address - Phone:270-446-9279
Mailing Address - Fax:
Practice Address - Street 1:777 ROCKY HILL ESTATES RD
Practice Address - Street 2:
Practice Address - City:CLARKSON
Practice Address - State:KY
Practice Address - Zip Code:42726-8441
Practice Address - Country:US
Practice Address - Phone:270-446-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2558051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical