Provider Demographics
NPI:1659971968
Name:BARRON, JESSICA STEVENSON
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:STEVENSON
Last Name:BARRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 JABEZ DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-8807
Mailing Address - Country:US
Mailing Address - Phone:731-693-6857
Mailing Address - Fax:
Practice Address - Street 1:33 DIRECTORS ROW
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2316
Practice Address - Country:US
Practice Address - Phone:731-313-7688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN72631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7263OtherLICENSED CLINICAL SOCIAL WORKER