Provider Demographics
NPI:1780959494
Name:BARNES, JESSICA RENA (LICSW, LISW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENA
Last Name:BARNES
Suffix:
Gender:F
Credentials:LICSW, LISW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RENA
Other - Last Name:GRIMSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW, LISW
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-0355
Mailing Address - Country:US
Mailing Address - Phone:712-490-4398
Mailing Address - Fax:402-494-3356
Practice Address - Street 1:1201 ARBOR DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-6877
Practice Address - Country:US
Practice Address - Phone:712-490-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14531041C0700X
IA0071941041C0700X
NE10111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical