Provider Demographics
NPI:1104226992
Name:DEVRIES, JESSICA (BA, MHP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:BA, MHP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GLENDENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:440 SUNBEAM CT
Mailing Address - Street 2:
Mailing Address - City:STILLMAN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61084-9010
Mailing Address - Country:US
Mailing Address - Phone:815-761-0071
Mailing Address - Fax:
Practice Address - Street 1:100 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1612
Practice Address - Country:US
Practice Address - Phone:815-732-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor