Provider Demographics
NPI:1154702272
Name:PATTERSON, JESSIE (LCSW)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:PATTERSON
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 1:2500 RIKE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-3937
Mailing Address - Country:US
Mailing Address - Phone:870-534-1834
Mailing Address - Fax:870-534-5798
Practice Address - Street 1:10800 FINANCIAL CENTRE PKWY STE 290
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3581
Practice Address - Country:US
Practice Address - Phone:501-781-2230
Practice Address - Fax:888-816-7916
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7641-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116378726Medicaid