Provider Demographics
NPI:1568003127
Name:ANDERSON, JESSICA K (LPC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412043
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2043
Mailing Address - Country:US
Mailing Address - Phone:314-935-6666
Mailing Address - Fax:314-696-1214
Practice Address - Street 1:1 BROOKINGS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4862
Practice Address - Country:US
Practice Address - Phone:314-935-6666
Practice Address - Fax:314-696-1214
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016045149101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490076035Medicaid