Provider Demographics
NPI:1740944420
Name:PASCH, JESSICA LOUISE (LCDCIII)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:PASCH
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:OH
Mailing Address - Zip Code:44804-9786
Mailing Address - Country:US
Mailing Address - Phone:419-350-7771
Mailing Address - Fax:
Practice Address - Street 1:205 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:OH
Practice Address - Zip Code:44804-9786
Practice Address - Country:US
Practice Address - Phone:419-350-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.182127101YA0400X, 101YA0400X
OHLCDCIII.162694101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.178703OtherCDCA