Doctor Name: | JESSICA L. KLEISS |
NPI Number: | 1194025668 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | |
Business Practice Address: | 750 Broadway Ave E Mattoon, IL - 619384610 |
Business Phone Number: | 2172385700 |
Business Fax Number: | 2172385767 |
Mailing Address: | 750 Broadway Ave E, MATTOON |
State: | IL |
Postal Code: | 619384610 |
Phone Number: | 2172385700 |
Fax Number: | 2172385767 |
NPI Enumeration Date: | 10/29/2010 |
NPI Last Update Date: | 10/29/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |