Provider Demographics
NPI:1215162573
Name:KIRBY, JESSICA L (LSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 ESSINGTON RD
Mailing Address - Street 2:STE. 109
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8447
Mailing Address - Country:US
Mailing Address - Phone:815-272-2010
Mailing Address - Fax:815-773-7340
Practice Address - Street 1:1150 ESSINGTON RD
Practice Address - Street 2:STE. 109
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8447
Practice Address - Country:US
Practice Address - Phone:815-272-2010
Practice Address - Fax:815-773-7340
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150011642104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker