Provider Demographics
NPI:1760041768
Name:HARDESTY, JESSALYN (LSW)
Entity Type:Individual
Prefix:
First Name:JESSALYN
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JESSALYN
Other - Middle Name:
Other - Last Name:HARDESTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:550 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1612
Mailing Address - Country:US
Mailing Address - Phone:740-291-3737
Mailing Address - Fax:833-805-3653
Practice Address - Street 1:550 MAIN ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1612
Practice Address - Country:US
Practice Address - Phone:740-291-3737
Practice Address - Fax:833-805-3653
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2005472104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker