Provider Demographics
NPI:1194519405
Name:VIOLA, JESSICA (LCPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VIOLA
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3695 6TH STREET FRONTAGE RD W STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-4753
Mailing Address - Country:US
Mailing Address - Phone:217-679-6344
Mailing Address - Fax:
Practice Address - Street 1:3695 6TH STREET FRONTAGE RD W STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4753
Practice Address - Country:US
Practice Address - Phone:217-679-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180016894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional