Provider Demographics
NPI:1770983579
Name:KING, JESSICA (MSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424A SABLE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8116
Mailing Address - Country:US
Mailing Address - Phone:219-508-7176
Mailing Address - Fax:
Practice Address - Street 1:424A SABLE DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-8116
Practice Address - Country:US
Practice Address - Phone:219-508-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker