Provider Demographics
NPI:1205100187
Name:WILLMANN, JESSICA ELIZABETH (PLPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:WILLMANN
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ELIZABETH
Other - Last Name:HANZLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1004 POWELL AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3136
Mailing Address - Country:US
Mailing Address - Phone:618-980-2332
Mailing Address - Fax:
Practice Address - Street 1:14615 MANCHESTER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3790
Practice Address - Country:US
Practice Address - Phone:314-488-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011031450101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor