Provider Demographics
NPI:1942809843
Name:GROGAN, JESSICA N (LICSW-S)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:GROGAN
Suffix:
Gender:F
Credentials:LICSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206-1615
Mailing Address - Country:US
Mailing Address - Phone:205-282-9091
Mailing Address - Fax:
Practice Address - Street 1:4 OFFICE PARK CIR STE 212
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2538
Practice Address - Country:US
Practice Address - Phone:205-281-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4416C-S101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor