Provider Demographics
NPI:1841543188
Name:JECKLIN, ALISSA CARA (LCSW)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:CARA
Last Name:JECKLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5549 HWY K
Mailing Address - Street 2:PO BOX 617
Mailing Address - City:BRIGHTON
Mailing Address - State:MO
Mailing Address - Zip Code:65617-0617
Mailing Address - Country:US
Mailing Address - Phone:417-376-2238
Mailing Address - Fax:
Practice Address - Street 1:5549 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MO
Practice Address - Zip Code:65617-7256
Practice Address - Country:US
Practice Address - Phone:417-376-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120250601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical