Provider Demographics
NPI:1891044699
Name:VASA, JESSICA L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:VASA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-7067
Mailing Address - Country:US
Mailing Address - Phone:405-878-1135
Mailing Address - Fax:405-878-1138
Practice Address - Street 1:101 N UNION AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-7067
Practice Address - Country:US
Practice Address - Phone:405-878-1135
Practice Address - Fax:405-878-1138
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health