Provider Demographics
NPI:1629324116
Name:SCHMIDT, JESSICA LYN (MS, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-0617
Mailing Address - Country:US
Mailing Address - Phone:641-236-0273
Mailing Address - Fax:641-236-7969
Practice Address - Street 1:812 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2143
Practice Address - Country:US
Practice Address - Phone:641-236-0273
Practice Address - Fax:641-236-7969
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001590101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program