Provider Demographics
NPI:1912215666
Name:PFEIFFER, JESSICA PAOLA (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:PAOLA
Last Name:PFEIFFER
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 1:2028 ASHMORE DR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-7805
Mailing Address - Country:US
Mailing Address - Phone:515-460-4446
Mailing Address - Fax:
Practice Address - Street 1:2028 ASHMORE DR
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7805
Practice Address - Country:US
Practice Address - Phone:515-460-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW000014001041C0700X
IA1292251041C0700X
IA129562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000196597Medicaid