Provider Demographics
NPI:1154738243
Name:PITERA, JESSICA (PLPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PITERA
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 W MCCARTY ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-1544
Mailing Address - Country:US
Mailing Address - Phone:573-691-7340
Mailing Address - Fax:
Practice Address - Street 1:718 W MCCARTY ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1544
Practice Address - Country:US
Practice Address - Phone:573-691-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014018387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional