Provider Demographics
NPI:1629659453
Name:PEAK, JESSICA C (BA MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:PEAK
Suffix:
Gender:F
Credentials:BA MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2225
Mailing Address - Country:US
Mailing Address - Phone:304-327-5305
Mailing Address - Fax:
Practice Address - Street 1:704 BLAND ST STE 507
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3540
Practice Address - Country:US
Practice Address - Phone:304-327-5305
Practice Address - Fax:304-327-6210
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator