Provider Demographics
NPI:1851856314
Name:SOPKO, JESSICA A (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:SOPKO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:STARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:357 KANSAS AVE SE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2517
Mailing Address - Country:US
Mailing Address - Phone:605-352-8596
Mailing Address - Fax:605-352-7001
Practice Address - Street 1:357 KANSAS AVE SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2517
Practice Address - Country:US
Practice Address - Phone:605-352-8596
Practice Address - Fax:605-352-7001
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD48431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4843OtherBOARD OF SOCIAL WORK EXAMINERS