Provider Demographics
NPI:1720049307
Name:CLAUSEN, JESSICA S (LISW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:CLAUSEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 5TH ST
Mailing Address - Street 2:SUITE 337
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1500
Mailing Address - Country:US
Mailing Address - Phone:712-301-1502
Mailing Address - Fax:
Practice Address - Street 1:505 5TH ST
Practice Address - Street 2:SUITE 337
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1500
Practice Address - Country:US
Practice Address - Phone:712-301-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA061931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05688OtherWELLMARK
IAI16727Medicare PIN
IAQ60034Medicare UPIN