Provider Demographics
NPI:1831515436
Name:SAMPSON, JESSICA (LSCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:PALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:212 SOUTH 4TH STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502
Mailing Address - Country:US
Mailing Address - Phone:785-323-0644
Mailing Address - Fax:785-323-0643
Practice Address - Street 1:212 SOUTH 4TH STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502
Practice Address - Country:US
Practice Address - Phone:785-323-0644
Practice Address - Fax:785-323-0643
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical