Provider Demographics
NPI:1992576979
Name:WATERS, JESSICA L (LADC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:WATERS
Suffix:
Gender:
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 W 135TH ST # 1368
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-9395
Mailing Address - Country:US
Mailing Address - Phone:913-280-6193
Mailing Address - Fax:
Practice Address - Street 1:1201 NW BRIARCLIFF PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-1878
Practice Address - Country:US
Practice Address - Phone:913-395-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COADDC.0000018101YA0400X
MO13207101YA0400X
101YP1600X
NE1523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral