Provider Demographics
NPI:1821530387
Name:CURTIS, JESSICA L (MSW, LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MSW, LISW, LICDC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:POLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11801 CHOCTAW DR
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45341-9736
Mailing Address - Country:US
Mailing Address - Phone:937-346-6101
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-262-5960
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161568101YA0400X
OHI.17005901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)