Provider Demographics
NPI:1770740391
Name:JESSEN, BARBARA CAROL (PSYD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:CAROL
Last Name:JESSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 RED WING DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-5249
Mailing Address - Country:US
Mailing Address - Phone:812-479-3454
Mailing Address - Fax:
Practice Address - Street 1:1535 RED WING DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-5249
Practice Address - Country:US
Practice Address - Phone:812-479-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010257A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100247020Medicaid