Provider Demographics
NPI:1669792040
Name:DODSON, JESSICA L (MSW, PCSW)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:L
Last Name:DODSON
Suffix:
Gender:F
Credentials:MSW, PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3885
Mailing Address - Country:US
Mailing Address - Phone:307-277-0132
Mailing Address - Fax:
Practice Address - Street 1:4422 E 25TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-3885
Practice Address - Country:US
Practice Address - Phone:307-277-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCSW-179101Y00000X
WYPCSW-1154104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor