Provider Demographics
NPI:1669936456
Name:TORBECK, JESSICA DAWN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:TORBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 N 350 ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-4505
Mailing Address - Country:US
Mailing Address - Phone:618-423-2779
Mailing Address - Fax:
Practice Address - Street 1:1984 N 350 ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-4505
Practice Address - Country:US
Practice Address - Phone:618-423-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool