Provider Demographics
NPI:1689363582
Name:STINSON, JESSICA (MSW, LCSW, SAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STINSON
Suffix:
Gender:F
Credentials:MSW, LCSW, SAC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:ANDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:421 COUNTY ROAD R
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-5129
Mailing Address - Country:US
Mailing Address - Phone:715-284-4301
Mailing Address - Fax:715-284-7713
Practice Address - Street 1:421 COUNTY ROAD R
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5129
Practice Address - Country:US
Practice Address - Phone:715-284-4301
Practice Address - Fax:715-284-7713
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8629-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical