Provider Demographics
NPI:1205720018
Name:SPANN, JESSICA (LSW, LCDCIII)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SPANN
Suffix:
Gender:F
Credentials:LSW, LCDCIII
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CLOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW,LCDCIII
Mailing Address - Street 1:4553 LONGFELLOW RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3338
Mailing Address - Country:US
Mailing Address - Phone:419-277-4049
Mailing Address - Fax:
Practice Address - Street 1:4553 LONGFELLOW RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3338
Practice Address - Country:US
Practice Address - Phone:419-277-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1201322104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker