| Doctor Name: | JESSICA MARIE DAUGHERTY |
| NPI Number: | 1427474253 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LLPC |
| License Number: | 6401014146 |
| Business Practice Address: | 960 M 60 E Cassopolis, MI - 490319339 |
| Business Phone Number: | 2698451734 |
| Business Fax Number: | |
| Mailing Address: | 1231 N Lafayette Blvd, SOUTH BEND |
| State: | IN |
| Postal Code: | 466171155 |
| Phone Number: | 7246747270 |
| Fax Number: | |
| NPI Enumeration Date: | 03/18/2014 |
| NPI Last Update Date: | 03/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401014146 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |