Provider Demographics
NPI:1083431589
Name:WOODRUFF, JESSICA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:WOODRUFF
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 1:7553 ALICIA AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-1201
Mailing Address - Country:US
Mailing Address - Phone:314-630-0192
Mailing Address - Fax:
Practice Address - Street 1:7553 ALICIA AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-1201
Practice Address - Country:US
Practice Address - Phone:314-630-0192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230380701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical