Provider Demographics
NPI:1134881667
Name:PAWLOWSKI, JESSICA SOOS (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SOOS
Last Name:PAWLOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SOOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11068 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW BUFFALO
Mailing Address - State:MI
Mailing Address - Zip Code:49117-9259
Mailing Address - Country:US
Mailing Address - Phone:773-407-0385
Mailing Address - Fax:
Practice Address - Street 1:11068 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:NEW BUFFALO
Practice Address - State:MI
Practice Address - Zip Code:49117-9259
Practice Address - Country:US
Practice Address - Phone:773-407-0385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011124531041C0700X
IL1490104641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical